Active NPI
John Patrick Demartino
- Optometrist
- Patchogue, NY
National Provider Identifier
1265257141
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 011111
- Practice address
- 499 Sunrise Hwy W Ste 80
Patchogue, NY 11772-2290 - Phone
- (631) 289-2010
- NPI assigned
- Nov 18, 2024
- Sex
- Male
- Sole proprietor
- Yes
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 | 011111 | NY | Primary |
Addresses
Primary practice location
499 Sunrise Hwy W Ste 80
Patchogue, NY 11772-2290
Mailing address
25 Verbena Dr
Commack, NY 11725-3716
Phone (631) 864-6922
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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20250716001961 | NY | Practitioner - Optometry | 6800301003 | Reassigns benefits to 1 organization |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1731888000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1731888000000",
"number": "1265257141",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "25 VERBENA DR",
"city": "COMMACK",
"state": "NY",
"postal_code": "117253716",
"telephone_number": "631-864-6922"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "499 SUNRISE HWY W STE 80",
"city": "PATCHOGUE",
"state": "NY",
"postal_code": "117722290",
"telephone_number": "631-289-2010"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DEMARTINO",
"first_name": "JOHN",
"middle_name": "PATRICK",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2024-11-18",
"last_updated": "2024-11-18",
"certification_date": "2024-11-17",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "NY",
"license": "011111",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Patchogue, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 18, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.