Active NPI
Lee Podberesky, O.D.
- Optometrist
- Monroe, NY
National Provider Identifier
1093884496
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- T004929-1
- Practice address
- 358 Mountain Ave
Monroe, NY 10950-1114 - Phone
- (845) 782-1837
- Fax
- (845) 774-8849
- NPI assigned
- Nov 7, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | T004929-1 | NY | Primary |
Addresses
Primary practice location
358 Mountain Ave
Monroe, NY 10950-1114
Mailing address
358 Mountain Ave
Monroe, NY 10950-1114
Phone (845) 782-1837
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 01691625 | Medicaid | NY |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| T004929-1 | NY | MD | Optometrist |
| 004929 | NY | MD | Acupuncturist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Riehle Opticians of Warwick, Inc | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Eyewear Supplier
- Warwick, NY
- NPI 1801813506
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1162857600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183939200000",
"number": "1093884496",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "358 MOUNTAIN AVE",
"city": "MONROE",
"state": "NY",
"postal_code": "109501114",
"telephone_number": "845-782-1837",
"fax_number": "845-774-8849"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "358 MOUNTAIN AVE",
"city": "MONROE",
"state": "NY",
"postal_code": "109501114",
"telephone_number": "845-782-1837",
"fax_number": "845-774-8849"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PODBERESKY",
"first_name": "LEE",
"name_prefix": "Dr.",
"credential": "O.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-11-07",
"last_updated": "2007-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "NY",
"license": "T004929-1",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "01691625",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Monroe, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.