Organization Active NPI

Pro Optics Corp

  • Optometrist
  • Bronx, NY
National Provider Identifier
1013171149
Registry record updated Mar 6, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
TUV005957-1 Issued in NY
Legal business name
PRO OPTICS CORP
Practice address
2483 Grand Concourse
Bronx, NY 10468-5443
Phone
(718) 933-0187
NPI assigned
Jul 17, 2008
Last updated
Mar 6, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 6, 2018

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

Authorized official

Name
Michelle Ericksen
Title
Assistant
Phone
(718) 933-0187

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X TUV005957-1 NY Primary

Addresses

Primary practice location

2483 Grand Concourse
Bronx, NY 10468-5443

Mailing address

2483 Grand Concourse
Bronx, NY 10468-5443
Phone (718) 933-0187

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20130919000105 NY Part B Supplier - Clinic/Group Practice 6204070980 Receives reassigned benefits from 6 practitioners
Practice locations: Bronx, NY

National Provider Directory

National Provider Directory

Locations

2483 Grand Concourse
Bronx, NY 10468
Phone (718) 933-0187

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": "1216252800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1520294400000",
    "number": "1013171149",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2483 GRAND CONCOURSE",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104685443",
            "telephone_number": "718-933-0187"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2483 GRAND CONCOURSE",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104685443",
            "telephone_number": "718-933-0187"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRO OPTICS CORP",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-07-17",
        "last_updated": "2018-03-06",
        "status": "A",
        "authorized_official_last_name": "ERICKSEN",
        "authorized_official_first_name": "MICHELLE",
        "authorized_official_title_or_position": "ASSISTANT",
        "authorized_official_telephone_number": "718-933-0187"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "NY",
            "license": "TUV005957-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bronx, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 6, 2018; 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.