NPIMap

Organization Active NPI

Larchmont Mamaroneck Eye Care Group

  • Optometrist
  • Mamaroneck, NY
National Provider Identifier
1164542916
Registry record updated Dec 9, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
TUV0045721 Issued in NY
Legal business name
LARCHMONT MAMARONECK EYE CARE GROUP
Practice address
933 Mamaroneck Ave
Mamaroneck, NY 10543-1662
Phone
(914) 698-2182
Fax
(914) 381-2676
NPI assigned
Mar 29, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 9, 2008

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

Authorized official

Name
Dr. Brian David Fengel, ODNPI 1912960626
Title
Owner
Phone
(914) 698-2182

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X TUV0045721 NY Primary

Addresses

Primary practice location

933 Mamaroneck Ave
Mamaroneck, NY 10543-1662

Mailing address

933 Mamaroneck Ave
Suite 105
Mamaroneck, NY 10543-1662
Phone (914) 698-2182

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20081208000478 NY Part B Supplier - Clinic/Group Practice 3476614561 Receives reassigned benefits from 1 practitioner
Practice locations: Mamaroneck, NY

National Provider Directory

National Provider Directory

Locations

933 Mamaroneck Ave
Ste 105
Mamaroneck, NY 10543
Phone (914) 698-2182

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1175126400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1228780800000",
    "number": "1164542916",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "933 MAMARONECK AVE",
            "address_2": "SUITE 105",
            "city": "MAMARONECK",
            "state": "NY",
            "postal_code": "105431662",
            "telephone_number": "914-698-2182",
            "fax_number": "914-381-2676"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "933 MAMARONECK AVE",
            "city": "MAMARONECK",
            "state": "NY",
            "postal_code": "105431662",
            "telephone_number": "914-698-2182",
            "fax_number": "914-381-2676"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LARCHMONT MAMARONECK EYE CARE GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-29",
        "last_updated": "2008-12-09",
        "status": "A",
        "authorized_official_last_name": "FENGEL",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_middle_name": "DAVID",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "914-698-2182",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "NY",
            "license": "TUV0045721",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mamaroneck, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 9, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.