Crystaleyes, LLC

Primary specialty

OptometristTaxonomy code 152W00000X

Legal business name

CRYSTALEYES, LLC

Practice address

1220 Tamarack Avenue
Independent Optometrists Inside of Costco
South Windsor, CT 06074-5572

Phone

(860) 474-4046

Fax

(860) 474-4045

NPI assigned

Mar 22, 2022

Organization subpart

No

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

Authorized official

Name

Dr. Devina Patel, O.D., FAAONPI 1588895700

Title

Owner, Managing Member

Phone

(860) 474-4046

Specialties & licenses 1

Addresses

Other identifiers 3

Other names 1

• Devina Patel, O.D., LLC Former legal business name

Medicare fee-for-service enrollment

Enrolled in CT

Enrollment records 1

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Devina P. Patel, O.D., F.A.A.O.

  • Optometrist
  • South Windsor, CT
  • NPI 1588895700
  Medicare reassignment Care Compare group NPD Authorized official
• Christina Marie Gonzalez, O.D.

  • Optometrist
  • East Windsor, CT
  • NPI 1831219278
  Medicare reassignment Care Compare group NPD
• Alireza Jabbari, O.D.

  • Optometrist
  • Hartford, CT
  • NPI 1538475132
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1647907200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1667779200000",
    "number": "1285383737",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1220 TAMARACK AVE",
            "city": "SOUTH WINDSOR",
            "state": "CT",
            "postal_code": "060745572",
            "telephone_number": "860-474-4046",
            "fax_number": "860-474-4045"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1220 TAMARACK AVENUE",
            "address_2": "INDEPENDENT OPTOMETRISTS INSIDE OF COSTCO",
            "city": "SOUTH WINDSOR",
            "state": "CT",
            "postal_code": "060745572",
            "telephone_number": "860-474-4046",
            "fax_number": "860-474-4045"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "44 Prospect Hill Rd, Ste 700",
            "address_2": "Independent Optometrists inside WalMart Vision Center",
            "address_purpose": "LOCATION",
            "city": "East Windsor",
            "state": "CT",
            "postal_code": "060889501",
            "country_code": "US",
            "telephone_number": "860-623-7910",
            "fax_number": "860-627-6433",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "CRYSTALEYES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-03-22",
        "last_updated": "2022-11-07",
        "certification_date": "2022-11-07",
        "status": "A",
        "authorized_official_last_name": "PATEL",
        "authorized_official_first_name": "DEVINA",
        "authorized_official_title_or_position": "OWNER, MANAGING MEMBER",
        "authorized_official_telephone_number": "860-474-4046",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D., FAAO"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1588895700",
            "state": "CT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1538475132",
            "state": "CT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1831219278",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Devina Patel, O.D., LLC",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "Devina Patel, O.D., LLC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Peter Michael Covello, LMFT
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• Evelyne Irimies Deloughery, APRN

• Optometrist in South Windsor, CT
• Providers in South Windsor, CT by specialty
• Optometrist in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 7, 2022; 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.