Putnam Vision Center

Primary specialty

OptometristTaxonomy code 152W00000X

License

002090 Issued in CT

Legal business name

PUTNAM VISION CENTER

Practice address

169 Grove St
Putnam, CT 06260-2115

Phone

(860) 963-2020

Fax

(860) 928-2040

NPI assigned

Mar 20, 2008

Organization subpart

No

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

Authorized official

Name

Kathy E Pellerin

Title

Insurance/Receptionest

Phone

(860) 963-2020

Specialties & licenses 1

Addresses

Other names 1

• David B Gaudreau, O.D. Other name

Medicare fee-for-service enrollment

Enrolled in CT2 enrollments

Enrollment records 2

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• David B Gaudreau, O.D.

  • Optometrist
  • Putnam, CT
  • NPI 1649241506
  Medicare reassignment NPD

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

{
    "created_epoch": "1205971200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1205971200000",
    "number": "1922279637",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "169 GROVE ST",
            "city": "PUTNAM",
            "state": "CT",
            "postal_code": "062602115",
            "telephone_number": "860-963-2020",
            "fax_number": "860-928-2040"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "169 GROVE ST",
            "city": "PUTNAM",
            "state": "CT",
            "postal_code": "062602115",
            "telephone_number": "860-963-2020",
            "fax_number": "860-928-2040"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PUTNAM VISION CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-03-20",
        "last_updated": "2008-03-20",
        "status": "A",
        "authorized_official_last_name": "PELLERIN",
        "authorized_official_first_name": "KATHY",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "INSURANCE/RECEPTIONEST",
        "authorized_official_telephone_number": "860-963-2020"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "CT",
            "license": "002090",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "David B Gaudreau, O.D.",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Putnam EMS Ambulance Service Inc
• Putnam Family Dental
• Putnam Family Dental PC
• Putnam Medical Associates PC
• Putnam Taxi LLC
• Aisha Quarshie
• Heather Child Quercia, LICSW AND LCSW
• Quiet Corner Acupuncture
• Quiet Corner Counseling Services LLC
• Quiet Corner Hearing AIDS

• Optometrist in Putnam, CT
• Providers in Putnam, CT by specialty
• Optometrist in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 20, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.