Jack Devore, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

VUT003734 Issued in NY

Practice address

4 Normanskill Blvd
Suite 400
Delmar, NY 12054-1335

Phone

(518) 478-9992

Fax

(518) 439-0796

NPI assigned

Jan 19, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 6

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

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Buenau's Opticians Inc

  • Durable Medical Equipment & Medical Supplies
  • Delmar, NY
  • NPI 1659425650
  Medicare reassignment NPD
• Jack Devore, OD

  • Eyewear Supplier
  • Delmar, NY
  • NPI 1013187178
  Authorized official Same address or phone
• New York Optometry Professional PLLC

  • Optometrist
  • Sidney, NY
  • NPI 1598470544
  NPD

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

{
    "created_epoch": "1137628800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1204070400000",
    "number": "1023098555",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4 NORMANSKILL BLVD",
            "address_2": "SUITE 400",
            "city": "DELMAR",
            "state": "NY",
            "postal_code": "120541335",
            "telephone_number": "518-478-9992",
            "fax_number": "518-439-0796"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4 NORMANSKILL BLVD",
            "address_2": "SUITE 400",
            "city": "DELMAR",
            "state": "NY",
            "postal_code": "120541335",
            "telephone_number": "518-478-9992",
            "fax_number": "518-439-0796"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEVORE",
        "first_name": "JACK",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-01-19",
        "last_updated": "2008-02-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NY",
            "license": "VUT003734",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CDPHP",
            "identifier": "10034805",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "EMPIRE BC",
            "identifier": "C6476",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BS NENY",
            "identifier": "000495454001",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILRAOD MEDICARE",
            "identifier": "410044002",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01419103",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MVP",
            "identifier": "59336",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jennifer Denis, FNP
• Marjorie K Dennin, PH.D.
• Xiang Dennison
• Wendy Marie Detwiler, LMSW
• Mary Terese Devoe
• Lisa Diana, MS.ED.
• Kyle William Dick, OTR/L
• Nicole Dieterle, RPH
• Dinapoli & Dinapoli, Inc.
• Dinapoli and Dinapoli, Inc.

• Optometrist in Delmar, NY
• Providers in Delmar, NY by specialty
• Optometrist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 27, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.