Active NPI
Eduard Shimanov
- Optician
- Oakland Gardens, NY
National Provider Identifier
1164546065
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optician
- License
- 007264
- Practice address
- 21411 73Rd Ave
Oakland Gardens, NY 11364-2947 - Phone
- (718) 225-5533
- NPI assigned
- Mar 17, 2007
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Optician | 156FX1800X | 007264 | NY | Primary |
Addresses
Primary practice location
21411 73Rd Ave
Oakland Gardens, NY 11364-2947
Mailing address
6922 184TH St
Fresh Meadows, NY 11365-3538
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 007264 | NY | MD | Primary Podiatric Medicine Podiatrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Windsor Park Vision Center, LTD | Past | Accepting new patients |
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.
-
- Eyewear Supplier
- Oakland Gardens, NY
- NPI 1164649133
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1174089600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1164546065",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6922 184TH ST",
"city": "FRESH MEADOWS",
"state": "NY",
"postal_code": "113653538"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "21411 73RD AVE",
"city": "OAKLAND GARDENS",
"state": "NY",
"postal_code": "113642947",
"telephone_number": "718-225-5533"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHIMANOV",
"first_name": "EDUARD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-03-17",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "156FX1800X",
"taxonomy_group": "",
"desc": "Technician/Technologist, Optician",
"state": "NY",
"license": "007264",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Oakland Gardens, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.