Organization Active NPI

North Shore Optometric Group, PC

  • Optometrist
  • Manhasset, NY
National Provider Identifier
1225330095
Registry record updated Dec 1, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
Legal business name
NORTH SHORE OPTOMETRIC GROUP, PC
Practice address
1129 Northern Blvd
Suite 100
Manhasset, NY 11030-3022
Phone
(516) 627-5656
Fax
(516) 627-5672
NPI assigned
Nov 29, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 1, 2010

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

Authorized official

Name
Dr. Larina Raquel Rosa, O.D.NPI 1023089539
Title
Secretary
Phone
(516) 627-5656

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 NY Primary

Addresses

Primary practice location

1129 Northern Blvd
Suite 100
Manhasset, NY 11030-3022

Mailing address

1129 Northern Blvd
Suite 100
Manhasset, NY 11030-3022
Phone (516) 627-5656

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110110000807 NY Part B Supplier - Clinic/Group Practice 9436348240 Receives reassigned benefits from 2 practitioners
Practice locations: Manhasset, NY; Smithtown, NY

National Provider Directory

National Provider Directory

Locations

1129 Northern Blvd
Ste 100
Manhasset, NY 11030
Phone (516) 627-5656

1129 Northern Blvd
Ste 306
Manhasset, NY 11030
Phone (516) 627-5656

1041 W Jericho Tpke
Ste C
Smithtown, NY 11787
Phone (631) 864-0100

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": "1290988800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1291161600000",
    "number": "1225330095",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1129 NORTHERN BLVD",
            "address_2": "SUITE 100",
            "city": "MANHASSET",
            "state": "NY",
            "postal_code": "110303022",
            "telephone_number": "516-627-5656",
            "fax_number": "516-627-5672"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1129 NORTHERN BLVD",
            "address_2": "SUITE 100",
            "city": "MANHASSET",
            "state": "NY",
            "postal_code": "110303022",
            "telephone_number": "516-627-5656",
            "fax_number": "516-627-5672"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTH SHORE OPTOMETRIC GROUP, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-11-29",
        "last_updated": "2010-12-01",
        "status": "A",
        "authorized_official_last_name": "ROSA",
        "authorized_official_first_name": "LARINA",
        "authorized_official_middle_name": "RAQUEL",
        "authorized_official_title_or_position": "SECRETARY",
        "authorized_official_telephone_number": "516-627-5656",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "NY",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Manhasset, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 1, 2010; 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.