Organization Active NPI

La Runnerstrom OD PLLC

Doing business as Greenbush Eye Center

  • Optometrist
  • East Greenbush, NY
National Provider Identifier
1053118273
Registry record updated May 21, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
Legal business name
LA RUNNERSTROM OD PLLC
Doing business as
Greenbush Eye Center
Practice address
749 Columbia Tpke
East Greenbush, NY 12061-2612
Phone
(518) 479-3306
Fax
(518) 479-4502
NPI assigned
Feb 26, 2025
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 21, 2025

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

Authorized official

Name
Dr. Laurie Runnerstrom, ODNPI 1922060888
Title
Owner/ Authorized Offical
Phone
(518) 479-3306

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193200000X MULTI-SPECIALTY GROUP 152W00000X Primary

Addresses

Primary practice location

749 Columbia Tpke
East Greenbush, NY 12061-2612

Mailing address

749 Columbia Tpke
East Greenbush, NY 12061-2612
Phone (518) 479-3306

Other names 1

  • Greenbush Eye Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20250530000727 NY Part B Supplier - Clinic/Group Practice 0749799922 Receives reassigned benefits from 1 practitioner
Practice locations: East Greenbush, NY

National Provider Directory

National Provider Directory

Locations

749 Columbia Tpke
East Greenbush, NY 12061
Phone (518) 479-2046

Practitioners & affiliated clinicians

Practitioners 1

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

NPI Registry JSON

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

{
    "created_epoch": "1740528000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1747785600000",
    "number": "1053118273",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "749 COLUMBIA TPKE",
            "city": "EAST GREENBUSH",
            "state": "NY",
            "postal_code": "120612612",
            "telephone_number": "518-479-3306",
            "fax_number": "518-479-4502"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "749 COLUMBIA TPKE",
            "city": "EAST GREENBUSH",
            "state": "NY",
            "postal_code": "120612612",
            "telephone_number": "518-479-3306",
            "fax_number": "518-479-4502"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LA RUNNERSTROM OD PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-02-26",
        "last_updated": "2025-05-21",
        "certification_date": "2025-05-21",
        "status": "A",
        "authorized_official_last_name": "RUNNERSTROM",
        "authorized_official_first_name": "LAURIE",
        "authorized_official_title_or_position": "OWNER/ AUTHORIZED OFFICAL",
        "authorized_official_telephone_number": "518-479-3306",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Greenbush Eye Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Greenbush Eye Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in East Greenbush, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 21, 2025; 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.