Liberty Optical Corp

Primary specialty

OptometristTaxonomy code 152W00000X

License

TUV007786 Issued in NY

Legal business name

LIBERTY OPTICAL CORP

Doing business as

Fabulous Optical

Practice address

12102 Liberty Ave
South Richmond Hill, NY 11419-2112

Phone

(718) 835-3400

NPI assigned

Aug 22, 2014

Last updated

Aug 22, 2014By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Mark Barayev

Title

Owner

Phone

(718) 835-3400

Specialties & licenses 1

Addresses

Other names 1

• Fabulous Optical Doing business as

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Vivek Goyal, OD

  • Optometrist
  • Jamaica, NY
  • NPI 1003461880
  Medicare reassignment NPD
• Anna Khesin, OD

  • Optometrist
  • South Richmond Hill, NY
  • NPI 1912429226
  Medicare reassignment NPD
• Ian Price Olexio, OD

  • Optometrist
  • Jamaica, NY
  • NPI 1184392490
  Medicare reassignment NPD
• Marina Presman, DOCTOR OF OPTOMETRY

  • Optometrist
  • Jamaica, NY
  • NPI 1699243600
  Medicare reassignment NPD
• Silena Rivera, OD

  • Optometrist
  • Staten Island, NY
  • NPI 1053827543
  Medicare reassignment NPD
• Gursewak Singh, OD

  • Optometrist
  • Brooklyn, NY
  • NPI 1891476347
  Medicare reassignment NPD
• Paul Obasuyi, OD

  • Optometrist
  • West Orange, NJ
  • NPI 1730463118

  NY

  Medicare reassignment NPD

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

{
    "created_epoch": "1408665600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1408665600000",
    "number": "1235538596",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12102 LIBERTY AVE",
            "city": "SOUTH RICHMOND HILL",
            "state": "NY",
            "postal_code": "114192112",
            "telephone_number": "718-835-3400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12102 LIBERTY AVE",
            "city": "SOUTH RICHMOND HILL",
            "state": "NY",
            "postal_code": "114192112",
            "telephone_number": "718-835-3400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIBERTY OPTICAL CORP",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-08-22",
        "last_updated": "2014-08-22",
        "status": "A",
        "authorized_official_last_name": "BARAYEV",
        "authorized_official_first_name": "MARK",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "718-835-3400",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "NY",
            "license": "TUV007786",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Fabulous Optical",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Liberty Footcare,PLLC
• Liberty Home Care Nurses Employment Agency Inc (Liberty Homecare)
• Liberty Home Care Nurses Employment Agency, Inc.
• Liberty Medical Pratice P.C
• Liberty Medicine&Rehab
• Liberty Pharmacy Inc.
• Liberty Pharmacy RX Inc
• Liberty Rock Pharmacy, Inc.
• Liberty Social Adult Day Care LLC
• Liberty Specs (lensmasters)

• Optometrist in South Richmond Hill, NY
• Providers in South Richmond Hill, NY by specialty
• Optometrist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2014; 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.