NPIMap

Organization Active NPI

DRS Sandra M Krokos & Thomas P Kislan PC

  • Optometrist
  • Nanticoke, PA
National Provider Identifier
1053010926
Registry record updated Aug 25, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
Legal business name
DRS SANDRA M KROKOS & THOMAS P KISLAN PC
Practice address
245 S Prospect St
Nanticoke, PA 18634-2443
Phone
(570) 735-6000
NPI assigned
Feb 28, 2023
Last updated
Aug 25, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 25, 2023

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

Authorized official

Name
Leslie Williams
Title
Practice Administrator
Phone
(570) 421-3342

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X Primary

Addresses

Primary practice location

245 S Prospect St
Nanticoke, PA 18634-2443

Mailing address

245 S Prospect St
Nanticoke, PA 18634-2443
Phone (570) 735-6000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040426000070 PA Part B Supplier - Clinic/Group Practice 6406842202 Receives reassigned benefits from 13 practitioners
4 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Bangor, PA; Hazletownship, PA; Nanticoke, PA; Pottsville, PA; Tannersville, PA
O20230817003305 PA DME Supplier - Physician - Optometrist 6406842202 Practice locations: Nanticoke, PA

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

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
Dr Sandra M Krokos Thomas4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 2

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": "1677542400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1692921600000",
    "number": "1053010926",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "245 S PROSPECT ST",
            "city": "NANTICOKE",
            "state": "PA",
            "postal_code": "186342443",
            "telephone_number": "570-735-6000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "245 S PROSPECT ST",
            "city": "NANTICOKE",
            "state": "PA",
            "postal_code": "186342443",
            "telephone_number": "570-735-6000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DRS SANDRA M KROKOS & THOMAS P KISLAN PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-02-28",
        "last_updated": "2023-08-25",
        "certification_date": "2023-08-25",
        "status": "A",
        "authorized_official_last_name": "WILLIAMS",
        "authorized_official_first_name": "LESLIE",
        "authorized_official_title_or_position": "PRACTICE ADMINISTRATOR",
        "authorized_official_telephone_number": "570-421-3342"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Nanticoke, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 25, 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.

Verify at the official NPI Registry.