Individual provider Active NPI

Mark Howard Grisar, O.D.

  • Optometrist
  • Yonkers, NY
National Provider Identifier
1285721886
Registry record updated May 5, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
VUT004040-01 Issued in NY
Practice address
1765 Central Park Ave
Yonkers, NY 10710-2828
Phone
(914) 961-1004
Fax
(914) 961-7636
NPI assigned
Oct 6, 2006
Last updated
May 5, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 5, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X VUT004040-01 NY Primary

Addresses

Primary practice location

1765 Central Park Ave
Yonkers, NY 10710-2828

Mailing address

1950 Old Gallows Rd Ste 520
Vienna, VA 22182-3970
Phone (703) 847-8899

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100125000338 NY Practitioner - Optometry 6103968441 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
004040NYMDBehavioral Analyst
VUT004040-01NYMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
200 West Optics, LLC Optometrist CurrentSince Jun 14, 2021 Accepting new patients
200 West Optics, LLC Optometrist CurrentSince Jun 14, 2021 Accepting new patients

Locations

1765 Central Park Ave
Yonkers, NY 10710
Phone (914) 961-1004

1950 Old Gallows Rd
Ste 520
Vienna, VA 22182

8614 Westwood Center Dr
Fl 9
Vienna, VA 22182

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1160092800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1620172800000",
    "number": "1285721886",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1950 OLD GALLOWS RD STE 520",
            "city": "VIENNA",
            "state": "VA",
            "postal_code": "221823970",
            "telephone_number": "703-847-8899",
            "fax_number": "571-223-6780"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1765 CENTRAL PARK AVE",
            "city": "YONKERS",
            "state": "NY",
            "postal_code": "107102828",
            "telephone_number": "914-961-1004",
            "fax_number": "914-961-7636"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRISAR",
        "first_name": "MARK",
        "middle_name": "HOWARD",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-06",
        "last_updated": "2021-05-05",
        "certification_date": "2021-05-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NY",
            "license": "VUT004040-01",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Yonkers, NY

Sources for this page

Verify at the official NPI Registry.