Active NPI
Nicole Elise Takita, OD
- Optometrist
- Dublin, PA
National Provider Identifier
1114540762
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- OEG003674
- Practice address
- 174 N Main St
Dublin, PA 18917-2001 - Phone
- (215) 249-3937
- NPI assigned
- May 18, 2020
- Sex
- Female
- Sole proprietor
- No
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 | OEG003674 | PA | Primary |
Addresses
Primary practice location
174 N Main St
Dublin, PA 18917-2001
Mailing address
174 N Main St
Dublin, PA 18917-2001
Other practice location 1
710 Floral Vale Blvd
Yardley, PA 19067-5529
Phone (215) 240-6378
Other names 1
- Nicole Elise Gruzin
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in PA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| OEG003674 | PA | MD | Optometrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Wisber Eye Care PC | Optometrist | Current | Accepting new patients |
Locations
174 N Main St
Dublin, PA 18917
Phone (215) 249-3937
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.
-
- Optometrist
- Dublin, PA
- NPI 1871053611
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1589760000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1592352000000",
"number": "1114540762",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "174 N MAIN ST",
"city": "DUBLIN",
"state": "PA",
"postal_code": "189172001"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "174 N MAIN ST",
"city": "DUBLIN",
"state": "PA",
"postal_code": "189172001",
"telephone_number": "215-249-3937"
}
],
"practiceLocations": [
{
"address_1": "710 Floral Vale Blvd",
"address_purpose": "LOCATION",
"city": "Yardley",
"state": "PA",
"postal_code": "190675529",
"country_code": "US",
"telephone_number": "215-240-6378",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "TAKITA",
"first_name": "NICOLE",
"middle_name": "ELISE",
"name_prefix": "Dr.",
"credential": "OD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-05-18",
"last_updated": "2020-06-17",
"certification_date": "2020-06-17",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "PA",
"license": "OEG003674",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "NICOLE",
"last_name": "GRUZIN",
"middle_name": "ELISE",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Dublin, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.