C Clearly Inc
Organization Active NPI Optometrist · Sunnyside, NY
NPI 1013215037 · NPPES record last updated Jul 21, 2022
Key facts
- NPI
- 1013215037
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Optometrist 152W00000X
- License
- TUV 005958 (NY)
- Legal business name
- C CLEARLY INC
- Practice address
- 4814 Skillman Ave
Sunnyside, NY 11104-1026 - Phone
- (347) 848-0982
- NPI assigned
- Mar 1, 2011
- Organization subpart
- No
Authorized official
- Name
- Dr. Christa J Cavallaro, OD
- Title
- President
- Phone
- (917) 687-8153
Practitioners 1
-
Christa J Cavallaro, O.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NY
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20110330000013 | NY | Part B Supplier - Clinic/Group Practice | 6103009113 |
Receives reassigned benefits from 1 practitioner Practice locations: Sunnyside, NY |
National Provider Directory
Locations
4814 Skillman Ave
Sunnyside, NY 11104
Phone (347) 848-0982
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist |
152W00000X | TUV 005958 | NY | Yes |
| Optometrist |
152W00000X |
Addresses
Primary practice location
4814 Skillman Ave
Sunnyside, NY 11104-1026
Mailing address
4814 Skillman Ave
Sunnyside, NY 11104-1026
Phone (917) 687-8153
Other providers in Sunnyside, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 21, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.