Martin Alex Mundackal, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

011180 Issued in NY

Practice address

4204 Broadway
New York, NY 10033-3706

Phone

(917) 920-2636

NPI assigned

Jun 30, 2025

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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

Specialty

Optometry

Education

State University of New York - State College Optometry, 2024

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

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.

• Vistasite Optique Inc

  • Ophthalmologic Surgery Clinic/Center
  • New York, NY
  • NPI 1578052791
  Medicare reassignment NPD

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

{
    "created_epoch": "1751241600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1751846400000",
    "number": "1114816634",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "212 BENEDICT AVE",
            "city": "THORNWOOD",
            "state": "NY",
            "postal_code": "105941204",
            "telephone_number": "212-433-0136"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4204 BROADWAY",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100333706",
            "telephone_number": "917-920-2636"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MUNDACKAL",
        "first_name": "MARTIN",
        "middle_name": "ALEX",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2025-06-30",
        "last_updated": "2025-07-07",
        "certification_date": "2025-07-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NY",
            "license": "011180",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shiv Ishta Munaswar, OD
• Kamran Munawar
• Garrett Munce
• Debora Soler Munczek, PH.D.
• Pamela A Mund, MD
• Nikita Mary Mundakel, MBBS, MD
• Lorraine Mundanchira
• Adam Richard Munday
• Sneh Preet Munder, MD
• Prabhjot Singh Mundi, M.D.

• Optometrist in New York, NY
• Providers in New York, NY by specialty
• Optometrist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 7, 2025; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.