NPIMap

Organization Active NPI

Redstone Eye Associates, LLC

  • Optometrist
  • Stoneham, MA
National Provider Identifier
1982783676
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
4307 Issued in MA
Legal business name
REDSTONE EYE ASSOCIATES, LLC
Practice address
75 Main St
Stoneham, MA 02180-3305
Phone
(781) 438-3372
Fax
(781) 438-3050
NPI assigned
Nov 3, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Siri Boonsirisermsook, O.D.NPI 1740369537
Title
Owner
Phone
(781) 438-3372

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 4307 MA Primary

Addresses

Primary practice location

75 Main St
Stoneham, MA 02180-3305

Mailing address

75 Main St
Stoneham, MA 02180-3305
Phone (781) 438-3372

Other identifiers 4

IdentifierTypeStateIssuer
MA4307OtherMAEYE MED VISION CARE
7734753OtherMAAETNA PROVIDER NUMBER
AA29247OtherMAHARVARD PILGRIM
W20386OtherMABLUE CROSS BLUE SHIELD

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050308000632 MA Part B Supplier - Clinic/Group Practice 7517911092 Receives reassigned benefits from 10 practitioners
Practice locations: Stoneham, MA

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 10

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.

NPI Registry JSON

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

{
    "created_epoch": "1162512000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1982783676",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "75 MAIN ST",
            "city": "STONEHAM",
            "state": "MA",
            "postal_code": "021803305",
            "telephone_number": "781-438-3372",
            "fax_number": "781-438-3050"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "75 MAIN ST",
            "city": "STONEHAM",
            "state": "MA",
            "postal_code": "021803305",
            "telephone_number": "781-438-3372",
            "fax_number": "781-438-3050"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REDSTONE EYE ASSOCIATES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-03",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "BOONSIRISERMSOOK",
        "authorized_official_first_name": "SIRI",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "781-438-3372",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MA",
            "license": "4307",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "EYE MED VISION CARE",
            "identifier": "MA4307",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA PROVIDER NUMBER",
            "identifier": "7734753",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HARVARD PILGRIM",
            "identifier": "AA29247",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "W20386",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Stoneham, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.