Individual provider Active NPI

Kerinna Molly McDonald, O.D.

  • Optometrist
  • Bayside, NY
National Provider Identifier
1194125468
Registry record updated Aug 24, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
TUV008157-1 Issued in NY
Practice address
4101 Bell Blvd
Bayside, NY 11361-2858
Phone
(718) 428-6700
NPI assigned
Aug 24, 2014
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 24, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X TUV008157-1 NY Primary

Addresses

Primary practice location

4101 Bell Blvd
Bayside, NY 11361-2858

Mailing address

4101 Bell Blvd
Bayside, NY 11361-2858
Phone (718) 428-6700

Other names 1

  • Dr. Kerinna Molly Coffey Former name

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150327002163 NY Practitioner - Optometry 4082931209 Reassigns benefits to 1 organization
Practice locations: Bayside, NY

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
TUV008157-1NYMDOptometrist
008157NYMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Danet Optical LTD Optometrist Past Accepting new patients
Bayside Vision Corp Optometrist PastSince Aug 6, 2023 Accepting new patients

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1408838400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1408838400000",
    "number": "1194125468",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4101 BELL BLVD",
            "city": "BAYSIDE",
            "state": "NY",
            "postal_code": "113612858",
            "telephone_number": "718-428-6700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4101 BELL BLVD",
            "city": "BAYSIDE",
            "state": "NY",
            "postal_code": "113612858",
            "telephone_number": "718-428-6700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCDONALD",
        "first_name": "KERINNA",
        "middle_name": "MOLLY",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-08-24",
        "last_updated": "2014-08-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NY",
            "license": "TUV008157-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KERINNA",
            "last_name": "COFFEY",
            "middle_name": "MOLLY",
            "prefix": "DR.",
            "credential": "O.D.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Bayside, NY

Sources for this page

Verify at the official NPI Registry.