Organization Active NPI

Super Vision Optical Inc

  • Optometrist
  • Brooklyn, NY
National Provider Identifier
1093804569
Registry record updated Sep 23, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
006605-1 Issued in NY
Legal business name
SUPER VISION OPTICAL INC
Practice address
8311 5TH Ave
Brooklyn, NY 11209-4510
Phone
(718) 491-2437
Fax
(718) 491-2438
NPI assigned
Oct 12, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 23, 2025

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

Authorized official

Name
Ms. Maria Moreno, OPTICIAN
Title
Owner
Phone
(718) 491-2437

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X 006605-1 NY Primary

Addresses

Primary practice location

8311 5TH Ave
Brooklyn, NY 11209-4510

Mailing address

8311 5TH Ave
Brooklyn, NY 11209-4510
Phone (718) 491-2437

Other identifiers 1

IdentifierTypeStateIssuer
01720007MedicaidNY

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20251001001824 NY Part B Supplier - Clinic/Group Practice 9830133958 Receives reassigned benefits from 1 practitioner
Practice locations: Brooklyn, NY

National Provider Directory

National Provider Directory

Locations

8311 5th Ave
Brooklyn, NY 11209
Phone (718) 491-2437

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": "1160611200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1758585600000",
    "number": "1093804569",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8311 5TH AVE",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112094510",
            "telephone_number": "718-491-2437",
            "fax_number": "718-491-2438"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8311 5TH AVE",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112094510",
            "telephone_number": "718-491-2437",
            "fax_number": "718-491-2438"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUPER VISION OPTICAL INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-12",
        "last_updated": "2025-09-23",
        "certification_date": "2025-09-23",
        "status": "A",
        "authorized_official_last_name": "MORENO",
        "authorized_official_first_name": "MARIA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "718-491-2437",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "OPTICIAN"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "NY",
            "license": "006605-1",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01720007",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Brooklyn, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 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.