Ethan Boryszak, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

TUV006999-1 Issued in NY

Practice address

5683 S Transit Rd
Lockport, NY 14094-5844

Phone

(716) 631-3860

NPI assigned

Jun 11, 2006

Sex

Male

Sole proprietor

Yes

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.

• Allegany Ophthalmology PLLC

  • Optometrist
  • Olean, NY
  • NPI 1760736946

  NY, Optometrist

  Medicare reassignment Care Compare group NPD
• Kenneth G Vandine MDPC

  • Ophthalmology Physician
  • Wellsville, NY
  • NPI 1881783819

  NY

  Medicare reassignment NPD
• Allegany Ophthalmology PLLC

  • Optometrist
  • Jamestown, NY
  • NPI 1730714742
  Care Compare group NPD
• Eye Mac Optometrists PC

  • Optometrist
  • Williamsville, NY
  • NPI 1750602991
  NPD (past)

Specialty

Optometry

Education

Other, 2005

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Allegany Ophthalmology PLLC 6 clinicians

Practice addresses (Care Compare)

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

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: ethanboryszakdo@alleganyeye.medentdirect.com

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Oct 16, 2008.

{
    "created_epoch": "1149984000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1224115200000",
    "number": "1124060751",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5683 S TRANSIT RD",
            "city": "LOCKPORT",
            "state": "NY",
            "postal_code": "140945844",
            "telephone_number": "716-631-3860"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5683 S TRANSIT RD",
            "city": "LOCKPORT",
            "state": "NY",
            "postal_code": "140945844",
            "telephone_number": "716-631-3860"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BORYSZAK",
        "first_name": "ETHAN",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-06-11",
        "last_updated": "2008-10-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NY",
            "license": "TUV006999-1",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNIVERA",
            "identifier": "1124060751",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "EYE MED",
            "identifier": "NY6999",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02748149",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Samantha Bonafede, LMSW
• Susan Lynne Booth
• Sandra Bordonaro, SPEECH THERAPIST
• Sara Borgstede
• Galina Bors
• Debra L Bramson, SLP
• Sarah Brandt-Douglas, LCSW-R
• Mark N Brandy
• Rebecca E Breezee, MS
• Joseph Peter Breloff, D.D.S., M.S.

• All providers in Lockport, NY
• Optometrist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 16, 2008; 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.