Active NPI
Michelle Yusupov
- Optometrist
- Forest Hills, NY
National Provider Identifier
1255247037
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 011478
- Practice address
- 11811 Queens Blvd
Forest Hills, NY 11375-7202 - Phone
- (718) 793-2461
- NPI assigned
- Aug 20, 2026
- Last updated
- Aug 20, 2026
- Sex
- Female
- Sole proprietor
- No
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 | 011478 | NY | Primary |
Addresses
Primary practice location
11811 Queens Blvd
Forest Hills, NY 11375-7202
Mailing address
10507 63Rd Ave
Forest Hills, NY 11375-1326
Phone (516) 417-0535
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Optical Choice Corp | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Optician
- Forest Hills, NY
- NPI 1922104785
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1787184000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1787184000000",
"number": "1255247037",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10507 63RD AVE",
"city": "FOREST HILLS",
"state": "NY",
"postal_code": "113751326",
"telephone_number": "516-417-0535"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11811 QUEENS BLVD",
"city": "FOREST HILLS",
"state": "NY",
"postal_code": "113757202",
"telephone_number": "718-793-2461"
}
],
"practiceLocations": [],
"basic": {
"last_name": "YUSUPOV",
"first_name": "MICHELLE",
"name_prefix": "Dr.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2026-08-20",
"last_updated": "2026-08-20",
"certification_date": "2026-08-20",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "NY",
"license": "011478",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Forest Hills, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.