Active NPI
Theodore Martin Devore, O.D.
- Optometrist
- Commack, NY
National Provider Identifier
1174684484
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 3350
- Practice address
- 6401 Jericho Tpke
Commack, NY 11725-2832 - Phone
- (631) 462-1188
- Fax
- (631) 462-5127
- NPI assigned
- Dec 12, 2006
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Optometrist | 152W00000X | 3350 | NY | Primary |
Addresses
Primary practice location
6401 Jericho Tpke
Commack, NY 11725-2832
Mailing address
6401 Jericho Tpke
Commack, NY 11725-2832
Phone (631) 462-1188
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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20081118000026 | NY | Practitioner - Optometry | 7113087479 | Practice locations: Commack, NY |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3350 | NY | MD | Optometrist |
| 003520 | NY | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1165881600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1711065600000",
"number": "1174684484",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6401 JERICHO TPKE",
"city": "COMMACK",
"state": "NY",
"postal_code": "117252832",
"telephone_number": "631-462-1188",
"fax_number": "631-462-5127"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6401 JERICHO TPKE",
"city": "COMMACK",
"state": "NY",
"postal_code": "117252832",
"telephone_number": "631-462-1188",
"fax_number": "631-462-5127"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DEVORE",
"first_name": "THEODORE",
"middle_name": "MARTIN",
"name_prefix": "Dr.",
"credential": "O.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-12-12",
"last_updated": "2024-03-22",
"certification_date": "2024-03-22",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "NY",
"license": "3350",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Commack, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 22, 2024; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.