Individual provider Active NPI

Ivona Leopoldina Kulusic, O.D.

  • Optometrist
  • New York, NY
National Provider Identifier
1114358058
Registry record updated Dec 3, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
T005637 Issued in NY
Practice address
2058 Lexington Ave
New York, NY 10035-1732
Phone
(212) 360-7422
NPI assigned
Dec 3, 2013
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 3, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X T005637 NY Primary

Addresses

Primary practice location

2058 Lexington Ave
New York, NY 10035-1732

Mailing address

2058 Lexington Ave
New York, NY 10035-1732
Phone (212) 360-7422

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)
Not enrolled

State licenses

LicenseStateTypeSpecialty
T005637NYMDOptometrist

NPI Registry JSON

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

{
    "created_epoch": "1386028800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1386028800000",
    "number": "1114358058",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2058 LEXINGTON AVE",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100351732",
            "telephone_number": "212-360-7422"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2058 LEXINGTON AVE",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100351732",
            "telephone_number": "212-360-7422"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KULUSIC",
        "first_name": "IVONA",
        "middle_name": "LEOPOLDINA",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-12-03",
        "last_updated": "2013-12-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NY",
            "license": "T005637",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New York, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 3, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.