Individual provider Active NPI

Effie Tatakis, O.D.

  • Optometrist
  • Brooklyn, NY
National Provider Identifier
1003055039
Registry record updated Oct 10, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
004950 Issued in NY
Practice address
2172 E 38TH St
Brooklyn, NY 11234-4930
Phone
(718) 434-0711
NPI assigned
Feb 15, 2009
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 10, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 004950 NY Primary

Addresses

Primary practice location

2172 E 38TH St
Brooklyn, NY 11234-4930

Mailing address

2019 Nostrand Ave
Brooklyn, NY 11210-2549
Phone (718) 434-0711

Medicare participation

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

Enrollment IDStateProvider typePAC IDDetails
I20090415000375 NY Practitioner - Optometry 2264589936 Reassigns benefits to 1 organization
Practice locations: Brooklyn, NY

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
004950NYMDAcupuncturist

Practice roles

OrganizationSpecialtyStatusNew patients
Be Well Primary Health Care Center, LLC CurrentSince Mar 10, 2009 Accepting new patients
New York Wellness PT PC Past Accepting new patients
Opti Fashion Inc Past Accepting new patients
Modern Vision, Inc Optometrist Past Accepting new patients

Locations

3007 Farragut Rd
Brooklyn, NY 11210
Phone (347) 915-1177

2019 Nostrand Ave
Brooklyn, NY 11210
Phone (347) 533-6180

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1234656000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1539129600000",
    "number": "1003055039",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2019 NOSTRAND AVE",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112102549",
            "telephone_number": "718-434-0711"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2172 E 38TH ST",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112344930",
            "telephone_number": "718-434-0711"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TATAKIS",
        "first_name": "EFFIE",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2009-02-15",
        "last_updated": "2018-10-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NY",
            "license": "004950",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brooklyn, NY

Sources for this page

Verify at the official NPI Registry.