Edward J Moylan OD PC

Primary specialty

OptometristTaxonomy code 152W00000X

License

TUV004922-1 Issued in NY

Legal business name

EDWARD J MOYLAN OD PC

Doing business as

North Shore Advanced Eye Care

Practice address

537 Patchogue Rd
Port Jefferson Station, NY 11776-1006

Phone

(631) 642-2020

Fax

(631) 642-3938

NPI assigned

Oct 5, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Edward J Moylan, ODNPI 1063588424

Title

Optometrist

Phone

(631) 642-2020

Specialties & licenses 1

Addresses

Other names 1

• North Shore Advanced Eye Care Doing business as

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Edward John Moylan, O.D.

  • Optometrist
  • Port Jefferson Station, NY
  • NPI 1063588424
  Medicare reassignment Care Compare group NPD Authorized official
• Julie Demartini, O.D.

  • Optometrist
  • Port Jefferson Station, NY
  • NPI 1316299449
  Medicare reassignment Care Compare group NPD
• Justin Daniel Kraushaar, O.D.

  • Optometrist
  • Shoreham, NY
  • NPI 1912262171
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1191542400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1647043200000",
    "number": "1043408958",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "537 PATCHOGUE RD",
            "city": "PORT JEFFERSON STATION",
            "state": "NY",
            "postal_code": "117761006",
            "telephone_number": "631-642-2020",
            "fax_number": "631-642-3938"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "537 PATCHOGUE RD",
            "city": "PORT JEFFERSON STATION",
            "state": "NY",
            "postal_code": "117761006",
            "telephone_number": "631-642-2020",
            "fax_number": "631-642-3938"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EDWARD J MOYLAN OD PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-05",
        "last_updated": "2022-03-12",
        "certification_date": "2022-03-12",
        "status": "A",
        "authorized_official_last_name": "MOYLAN",
        "authorized_official_first_name": "EDWARD",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "OPTOMETRIST",
        "authorized_official_telephone_number": "631-642-2020",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "NY",
            "license": "TUV004922-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "North Shore Advanced Eye Care",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "North Shore Advanced Eye Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Pallavi Aishwarya Duvvuri
• Brian Dwyer, P.T.
• East End Hearing and Speech
• Cheryl Edelstein
• Jenna Edlin, PA-C
• Laura Edwards
• Sheri Renee Anna Egert, OTR/L
• Luis J Ehrman Sr., ANP-C
• Maria Eliades, DMD
• Ellen J Gordon Licensed Master Social Worker PC

• Optometrist in Port Jefferson Station, NY
• Providers in Port Jefferson Station, NY by specialty
• Optometrist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 12, 2022; 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.