Jonathan Pena OD PC

Primary specialty

OptometristTaxonomy code 152W00000X

Legal business name

JONATHAN PENA OD PC

Practice address

278 Barker St
North Andover, MA 01845-1123

Phone

(617) 356-8117

NPI assigned

Sep 15, 2019

Last updated

Sep 27, 2019By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. David Gibson, OD

Title

Chief Medical Officer

Phone

(919) 880-6066

Specialties & licenses 1

Addresses

Electronic endpoints 1

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

{
    "created_epoch": "1568505600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1569542400000",
    "number": "1912557646",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "278 BARKER ST",
            "city": "NORTH ANDOVER",
            "state": "MA",
            "postal_code": "018451123"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "278 BARKER ST",
            "city": "NORTH ANDOVER",
            "state": "MA",
            "postal_code": "018451123",
            "telephone_number": "617-356-8117"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JONATHAN PENA OD PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-09-15",
        "last_updated": "2019-09-27",
        "status": "A",
        "authorized_official_last_name": "GIBSON",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "CHIEF MEDICAL OFFICER",
        "authorized_official_telephone_number": "919-880-6066",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "Uprise",
            "affiliation": "N",
            "endpointDescription": "Practice Software",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "278 Barker St",
            "city": "North Andover",
            "state": "MA",
            "country_code": "US",
            "postal_code": "018451123",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Optometrist in North Andover, MA
• Providers in North Andover, MA by specialty
• Optometrist in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 27, 2019; 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.