Route 33 Eye Care & Optical Boutique LLC

Primary specialty

OptometristTaxonomy code 152W00000X

Legal business name

ROUTE 33 EYE CARE & OPTICAL BOUTIQUE LLC

Practice address

1013 S Talbot St
Saint Michaels, MD 21663-2637

Phone

(954) 298-9913

NPI assigned

Mar 20, 2023

Last updated

Jun 5, 2023By 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. Kelly M Cooper, O.D.NPI 1124628300

Title

Owner/Optometrist

Phone

(954) 298-9913

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MD

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Kelly M Cooper

  • Optometrist
  • St. Michael's, MD
  • NPI 1124628300
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1679270400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1685923200000",
    "number": "1932801362",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "510 TENANT CIR",
            "city": "SAINT MICHAELS",
            "state": "MD",
            "postal_code": "216632873",
            "telephone_number": "954-298-9913"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1013 S TALBOT ST",
            "city": "SAINT MICHAELS",
            "state": "MD",
            "postal_code": "216632637",
            "telephone_number": "954-298-9913"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROUTE 33 EYE CARE & OPTICAL BOUTIQUE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-03-20",
        "last_updated": "2023-06-05",
        "certification_date": "2023-06-05",
        "status": "A",
        "authorized_official_last_name": "COOPER",
        "authorized_official_first_name": "KELLY",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "OWNER/OPTOMETRIST",
        "authorized_official_telephone_number": "954-298-9913",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Pemberton Pharmacy & Gift St Michaels, LLC
• Hunter Green Plog, RD, LDN
• Kendall Reck
• Reeser's Pharmacy Inc.
• Robert J Patterson, MD LLC
• Russell Alan Schilling, DO
• Craig Allen Schury, RPH
• Richard John Snow, D.O.
• St. Michaels School
• Kelley Stewart

• Optometrist in St. Michael's, MD
• Providers in St. Michael's, MD by specialty
• Optometrist in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 5, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.