Individual provider Active NPI

Jamie Wang

  • Optometrist
  • Flushing, NY
National Provider Identifier
1114607215
Registry record updated Jul 1, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
009901 Issued in NY
Practice address
13620 Maple Ave # C701
Flushing, NY 11355-5166
Phone
(917) 621-9283
Fax
(347) 510-0088
NPI assigned
Jul 24, 2023
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 1, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 009901 NY Primary

Addresses

Primary practice location

13620 Maple Ave # C701
Flushing, NY 11355-5166

Mailing address

13620 Maple Ave # C701
Flushing, NY 11355-5166

Other practice location 1

13668 Roosevelt Ave Ste Cb
Flushing, NY 11354-5510
Phone (917) 621-9283

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240618000390 NY Practitioner - Optometry 2466995568 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
New England College of Optometry, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Stargaze Eye Care Optometry P.C.Group PAC ID 8527373679, 2 clinicians

Practice addresses (Care Compare)

13620 Maple Ave
C701
Flushing, NY 11355-5166
Phone (917) 621-9283

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Stargaze Eye Care Optometry P.C. Optometrist CurrentSince May 8, 2024 Accepting new patients

Locations

13620 Maple Ave
#C701
Flushing, NY 11355
Phone (917) 621-9283

13668 Roosevelt Ave
Ste Cb
Flushing, NY 11354
Phone (917) 621-9283

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.

NPI Registry JSON

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

{
    "created_epoch": "1690156800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1719792000000",
    "number": "1114607215",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13620 MAPLE AVE # C701",
            "city": "FLUSHING",
            "state": "NY",
            "postal_code": "113555166"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13620 MAPLE AVE # C701",
            "city": "FLUSHING",
            "state": "NY",
            "postal_code": "113555166",
            "telephone_number": "917-621-9283",
            "fax_number": "347-510-0088"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "13668 Roosevelt Ave Ste Cb",
            "address_purpose": "LOCATION",
            "city": "Flushing",
            "state": "NY",
            "postal_code": "113545510",
            "country_code": "US",
            "telephone_number": "917-621-9283",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WANG",
        "first_name": "JAMIE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-07-24",
        "last_updated": "2024-07-01",
        "certification_date": "2024-07-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NY",
            "license": "009901",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Flushing, NY

Sources for this page

Verify at the official NPI Registry.