NPIMap

Organization Active NPI

Westfall Vision, LLC

  • Ophthalmology Physician
  • Glens Falls, NY
National Provider Identifier
1083303903
Registry record updated Jul 2, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
Legal business name
WESTFALL VISION, LLC
Practice address
15 E Washington St
Glens Falls, NY 12801-3315
Phone
(518) 792-5711
Fax
(518) 792-5723
NPI assigned
May 5, 2023
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 2, 2023

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

Authorized official

Name
Dr. Joanne Detore, DMSC RPACNPI 1396724894
Title
Coo
Phone
(518) 744-9911

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 3

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193200000X MULTI-SPECIALTY GROUP 152W00000X
Ophthalmology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207W00000X Primary
Physician AssistantGroup: 193200000X MULTI-SPECIALTY GROUP 363A00000X

Addresses

Primary practice location

15 E Washington St
Glens Falls, NY 12801-3315

Mailing address

15 E Washington St
Glens Falls, NY 12801-3315
Phone (518) 792-5711

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20230808000084 NY Part B Supplier - Clinic/Group Practice 6305207382 Receives reassigned benefits from 4 practitioners
Practice locations: Glens Falls, NY

National Provider Directory

National Provider Directory

Locations

15 E Washington St
Glens Falls, NY 12801
Phone (518) 761-2020

Practitioners & affiliated clinicians

Practitioners 4

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": "1683244800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1688256000000",
    "number": "1083303903",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15 E WASHINGTON ST",
            "city": "GLENS FALLS",
            "state": "NY",
            "postal_code": "128013315",
            "telephone_number": "518-792-5711",
            "fax_number": "518-792-5723"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15 E WASHINGTON ST",
            "city": "GLENS FALLS",
            "state": "NY",
            "postal_code": "128013315",
            "telephone_number": "518-792-5711",
            "fax_number": "518-792-5723"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WESTFALL VISION, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-05-05",
        "last_updated": "2023-07-02",
        "certification_date": "2023-07-02",
        "status": "A",
        "authorized_official_last_name": "DETORE",
        "authorized_official_first_name": "JOANNE",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "518-744-9911",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMSC RPAC"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Ophthalmology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Glens Falls, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 2, 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.