20 20 Optometry Services, PC
Organization Active NPI Optometrist · Ridgewood, NY
NPI 1063933430 · NPPES record last updated Nov 3, 2017
Key facts
- NPI
- 1063933430
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Optometrist 152W00000X
- License
- 008499 (NY)
- Legal business name
- 20 20 OPTOMETRY SERVICES, PC
- Practice address
- 6240 Forest Ave
Ridgewood, NY 11385-1929 - Phone
- (718) 418-0300
- Fax
- (718) 418-0301
- NPI assigned
- Jul 6, 2017
- Organization subpart
- No
Authorized official
- Name
- Dr. Elizabeth Yusupov, OD
- Title
- OD
- Phone
- (718) 418-0300
Practitioners 1
-
Elizabeth Yusupov, O.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NY
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20170830000951 | NY | Part B Supplier - Clinic/Group Practice | 8628341443 |
Receives reassigned benefits from 1 practitioner Practice locations: Ridgewood, NY |
National Provider Directory
Locations
5629 Metropolitan Ave
Ridgewood, NY 11385
Phone (718) 418-0300
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist |
152W00000X | 008499 | NY | Yes |
Addresses
Primary practice location
6240 Forest Ave
Ridgewood, NY 11385-1929
Mailing address
10231 65TH Rd
Forest Hills, NY 11375-1740
Phone (718) 418-0300
Other providers in Ridgewood, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 3, 2017. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.