Active NPI
James Francis McCullough, RDO
- Optician
- Southbridge, MA
National Provider Identifier
1972666212
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optician
- License
- MA1543
- Practice address
- 343 Main Street
Southbridge Spectacle Shop
Southbridge, MA 01550 - Phone
- (508) 765-9607
- NPI assigned
- Dec 18, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optician | 156FX1800X | MA1543 | MA | Primary |
Addresses
Primary practice location
343 Main Street
Southbridge Spectacle Shop
Southbridge, MA 01550
Mailing address
343 Main Street
Southbridge, MA 01550
Phone (508) 765-9607
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1522191 | Medicaid | MA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MA1543 | MA | MD | Optician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1166400000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1972666212",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "343 MAIN STREET",
"city": "SOUTHBRIDGE",
"state": "MA",
"postal_code": "01550",
"telephone_number": "508-765-9607",
"fax_number": "508-765-9607"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "343 MAIN STREET",
"address_2": "SOUTHBRIDGE SPECTACLE SHOP",
"city": "SOUTHBRIDGE",
"state": "MA",
"postal_code": "01550",
"telephone_number": "508-765-9607"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MCCULLOUGH",
"first_name": "JAMES",
"middle_name": "FRANCIS",
"name_prefix": "Mr.",
"credential": "RDO",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-12-18",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "156FX1800X",
"taxonomy_group": "",
"desc": "Technician/Technologist, Optician",
"state": "MA",
"license": "MA1543",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1522191",
"state": "MA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Southbridge, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.