Active NPI
Mia Kercado, LDO
- Optician
- Bristol, CT
National Provider Identifier
1902673957
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optician
- License
- 1900
- Practice address
- 1400 Farmington Ave
Bristol, CT 06010-4701 - Phone
- (860) 585-1156
- Fax
- (860) 585-1160
- NPI assigned
- Dec 11, 2023
- Last updated
- Dec 11, 2023
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optician | 156FX1800X | 1900 | CT | Primary |
Addresses
Primary practice location
1400 Farmington Ave
Bristol, CT 06010-4701
Mailing address
1400 Farmington Ave
Bristol, CT 06010-4701
Phone (860) 585-1156
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1900 | CT | MD | Behavioral Analyst |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1702252800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1702252800000",
"number": "1902673957",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1400 FARMINGTON AVE",
"city": "BRISTOL",
"state": "CT",
"postal_code": "060104701",
"telephone_number": "860-585-1156",
"fax_number": "860-585-1160"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1400 FARMINGTON AVE",
"city": "BRISTOL",
"state": "CT",
"postal_code": "060104701",
"telephone_number": "860-585-1156",
"fax_number": "860-585-1160"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KERCADO",
"first_name": "MIA",
"credential": "LDO",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-12-11",
"last_updated": "2023-12-11",
"certification_date": "2023-12-09",
"status": "A"
},
"taxonomies": [
{
"code": "156FX1800X",
"taxonomy_group": "",
"desc": "Technician/Technologist, Optician",
"state": "CT",
"license": "1900",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bristol, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 11, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.