Active NPI
Nyc Optical Group LLC
- Optometrist
- Brooklyn, NY
National Provider Identifier
1023655883
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- Legal business name
- NYC OPTICAL GROUP LLC
- Practice address
- 5623 5TH Ave
Brooklyn, NY 11220-3414 - Phone
- (718) 635-9333
- NPI assigned
- Nov 28, 2019
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Andrey Gan
- Title
- Owner
- Phone
- (718) 902-9592
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | Primary |
Addresses
Primary practice location
5623 5TH Ave
Brooklyn, NY 11220-3414
Mailing address
1354 Pennsylvania Ave
Brooklyn, NY 11239-2111
Phone (718) 642-3526
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NY
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20190614001722 | NY | Part B Supplier - Clinic/Group Practice | 8123351665 |
Receives reassigned benefits from 7 practitioners 6 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Brooklyn, NY; Bronx, NY |
Other NPIs on the same Medicare enrollment 4
NPIs listed together on one Medicare enrollment, typically parts of the same organization.
National Provider Directory
National Provider Directory- Tax ID family
- Nyc Optical Group LLC
Other organizations with this tax ID 2
Organizations that report the same tax identification number in the National Provider Directory.
-
- Optometrist
- Bronx, NY
- NPI 1659268373
-
- Optometrist
- Brooklyn, NY
- NPI 1922616499
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1574899200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1702944000000",
"number": "1023655883",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1354 PENNSYLVANIA AVE",
"city": "BROOKLYN",
"state": "NY",
"postal_code": "112392111",
"telephone_number": "718-642-3526"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5623 5TH AVE",
"city": "BROOKLYN",
"state": "NY",
"postal_code": "112203414",
"telephone_number": "718-635-9333"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "NYC OPTICAL GROUP LLC",
"organizational_subpart": "NO",
"enumeration_date": "2019-11-28",
"last_updated": "2023-12-19",
"certification_date": "2023-12-19",
"status": "A",
"authorized_official_last_name": "GAN",
"authorized_official_first_name": "ANDREY",
"authorized_official_title_or_position": "OWNER",
"authorized_official_telephone_number": "718-902-9592"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Optometrist",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Brooklyn, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 19, 2023; 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.