Organization Active NPI

Clearview Eye Surgery, PC

  • Ophthalmology Physician
  • New York, NY
National Provider Identifier
1174884563
Registry record updated Jun 2, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
License
218603 Issued in NY
Legal business name
CLEARVIEW EYE SURGERY, PC
Practice address
1825 Riverside Dr
Suite 1B
New York, NY 10034-5307
Phone
(212) 304-2010
Fax
(212) 304-2015
NPI assigned
Jun 2, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 2, 2012

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

Authorized official

Name
John J Kim, M.D.NPI 1114000635
Title
Owner
Phone
(212) 304-2010

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
Ophthalmology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207W00000X 218603 NY Primary

Addresses

Primary practice location

1825 Riverside Dr
Suite 1B
New York, NY 10034-5307

Mailing address

1825 Riverside Dr
Suite 1B
New York, NY 10034-5307
Phone (212) 304-2010

Other identifiers 1

IdentifierTypeStateIssuer
02558354MedicaidNY

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120709000275 NY Part B Supplier - Clinic/Group Practice 4486819984 Receives reassigned benefits from 5 practitioners
Practice locations: Mount Vernon, NY; New York, NY; Glendale, NY; Flushing, NY; Bronx, NY

National Provider Directory

National Provider Directory

Locations

1101 Pelham Pkwy N
Bronx, NY 10469
Phone (718) 515-3500

Practitioners & affiliated clinicians

Practitioners 8

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": "1338595200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1338595200000",
    "number": "1174884563",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1825 RIVERSIDE DR",
            "address_2": "SUITE 1B",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100345307",
            "telephone_number": "212-304-2010",
            "fax_number": "212-304-2015"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1825 RIVERSIDE DR",
            "address_2": "SUITE 1B",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100345307",
            "telephone_number": "212-304-2010",
            "fax_number": "212-304-2015"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLEARVIEW EYE SURGERY, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-06-02",
        "last_updated": "2012-06-02",
        "status": "A",
        "authorized_official_last_name": "KIM",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "212-304-2010",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Ophthalmology",
            "state": "NY",
            "license": "218603",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02558354",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in New York, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 2, 2012; 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.