NPIMap

Organization Active NPI

Vine Brook Eyecare LLC

  • Optometrist
  • Burlington, MA
National Provider Identifier
1881144079
Registry record updated Jun 15, 2017
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Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
4681 Issued in MA
Legal business name
VINE BROOK EYECARE LLC
Practice address
1300 Middlesex Turnpike
Burlington, MA 01803
Phone
(781) 238-6141
NPI assigned
Oct 11, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 15, 2017

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Darina Polsonetti, O.D.
Title
Owner
Phone
(978) 578-0491

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X 4681 MA Primary

Addresses

Primary practice location

1300 Middlesex Turnpike
Burlington, MA 01803

Mailing address

120 Orchard St
Tewksbury, MA 01876-2095

Other names 1

  • Polsonetti Optometry LLC Former legal business name

National Provider Directory

National Provider Directory

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1476144000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1497484800000",
    "number": "1881144079",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "120 ORCHARD ST",
            "city": "TEWKSBURY",
            "state": "MA",
            "postal_code": "018762095"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1300 MIDDLESEX TURNPIKE",
            "city": "BURLINGTON",
            "state": "MA",
            "postal_code": "01803",
            "telephone_number": "781-238-6141"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VINE BROOK EYECARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-10-11",
        "last_updated": "2017-06-15",
        "status": "A",
        "authorized_official_last_name": "POLSONETTI",
        "authorized_official_first_name": "DARINA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "978-578-0491",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "MA",
            "license": "4681",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Polsonetti Optometry LLC",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "Polsonetti Optometry LLC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Burlington, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 15, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.