Active NPI
Kevin Donald Kooistra, OPTICIAN
- Optician
- Clifton, NJ
National Provider Identifier
1326113994
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optician
- License
- 31TD00190700
- Practice address
- 1033 Clifton Ave
Suite 107
Clifton, NJ 07013-3517 - Phone
- (973) 471-1225
- Fax
- (973) 472-4835
- NPI assigned
- Nov 21, 2006
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Optician | 156FX1800X | 31TD00190700 | NJ | Primary |
Addresses
Primary practice location
1033 Clifton Ave
Suite 107
Clifton, NJ 07013-3517
Mailing address
1033 Clifton Ave
Suite 107
Clifton, NJ 07013-3517
Phone (973) 471-1225
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 31TD00190700 | NJ | MD | Optician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Alessandra Bertolucci MD LLC | Optician | 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 and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1164067200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1319587200000",
"number": "1326113994",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1033 CLIFTON AVE",
"address_2": "SUITE 107",
"city": "CLIFTON",
"state": "NJ",
"postal_code": "070133517",
"telephone_number": "973-471-1225",
"fax_number": "973-472-4835"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1033 CLIFTON AVE",
"address_2": "SUITE 107",
"city": "CLIFTON",
"state": "NJ",
"postal_code": "070133517",
"telephone_number": "973-471-1225",
"fax_number": "973-472-4835"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KOOISTRA",
"first_name": "KEVIN",
"middle_name": "DONALD",
"name_prefix": "Mr.",
"credential": "OPTICIAN",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-11-21",
"last_updated": "2011-10-26",
"status": "A"
},
"taxonomies": [
{
"code": "156FX1800X",
"taxonomy_group": "",
"desc": "Technician/Technologist, Optician",
"state": "NJ",
"license": "31TD00190700",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Clifton, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 26, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.