Robert John Connelly, O.D.
Individual provider Active NPI Optometrist · Stamford, NY
NPI 1922162148 · NPPES record last updated Mar 20, 2008
Key facts
- NPI
- 1922162148
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Optometrist 152W00000X
- License
- 004654 (NY)
- Practice address
- 22 Harper St
Stamford, NY 12167-0088 - Phone
- (607) 652-7207
- Fax
- (607) 652-4753
- NPI assigned
- Dec 21, 2006
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare Care Compare profile
- Specialty
- Optometry
- Education
- New England College of Optometry, 1986
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
22 Harper St
Stamford, NY 12167-1049
Phone (607) 652-7207
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NY
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20060327000763 | NY | Practitioner - Optometry | 0244248805 | Practice locations: Stamford, NY |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4654 | NY | MD | Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Robert J. Connelly | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 004654 | NY | Yes |
Addresses
Primary practice location
22 Harper St
Stamford, NY 12167-0088
Mailing address
22 Harper St
PO Box 88
Stamford, NY 12167-0088
Phone (607) 652-7207
Other providers in Stamford, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 20, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.