Ronald Kiyoshi Watanabe, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

3763 Issued in MA

Practice address

15 Central St
Andover, MA 01810-3718

Phone

(978) 475-5252

Fax

(978) 475-2226

NPI assigned

Jul 28, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 7

Other names 1

• Ronald K Watanabe Professional name

Medicare fee-for-service enrollment

Enrolled in MA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Optometry

Education

Southern California College of Optometry, 1991

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Aeg Massachusetts Professional PCGroup PAC ID 6901282557, 44 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Aeg Massachusetts Professional PC

  • Optometrist
  • Andover, MA
  • NPI 1952035040
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1122508800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1282521600000",
    "number": "1942200316",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15 CENTRAL ST",
            "city": "ANDOVER",
            "state": "MA",
            "postal_code": "018103718",
            "telephone_number": "978-475-5252",
            "fax_number": "978-475-2226"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15 CENTRAL ST",
            "city": "ANDOVER",
            "state": "MA",
            "postal_code": "018103718",
            "telephone_number": "978-475-5252",
            "fax_number": "978-475-2226"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WATANABE",
        "first_name": "RONALD",
        "middle_name": "KIYOSHI",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-07-28",
        "last_updated": "2010-08-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MA",
            "license": "3763",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "COVENTRY",
            "identifier": "1552937",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TUFTS",
            "identifier": "402787",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "W16025",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "COMP BENEFITS",
            "identifier": "610461",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FALLON",
            "identifier": "54742",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HARVARD PILGRIM",
            "identifier": "153220",
            "state": "MA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "317390",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "RONALD",
            "last_name": "WATANABE",
            "middle_name": "K",
            "credential": "OD",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Alexsis Walter, CNP
• Afeni Wando
• Taylor Craig Ware, LICSW
• Melissa Tsuang Warner, PA-C
• Emily Brooke Wasser
• We-Cope Counseling & Consulting LLC
• Dawn D Webber
• Janel Marie Weiner, LICSW
• Olivia O'Gorman Weiser, LCSW
• Rachel Leigh Weldon, MS, LMHC

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 23, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.