Jessica Licausi, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

TUV007703-1 Issued in NY

Practice address

25 Cranberry St Ste a
Riverhead, NY 11901-2762

Phone

(631) 740-9384

NPI assigned

Jul 26, 2011

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Dr. Jessica Fulmer Former name

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

Specialty

Optometry

Education

State University of New York - State College Optometry, 2011

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Twin Forks Optometry PLLCGroup PAC ID 1557678422, 2 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Twin Forks Optometry, PLLC

  • Optometrist
  • Riverhead, NY
  • NPI 1699155549
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1311638400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1566950400000",
    "number": "1326326224",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25 CRANBERRY ST",
            "address_2": "SUITE A",
            "city": "RIVERHEAD",
            "state": "NY",
            "postal_code": "119012762",
            "telephone_number": "631-740-9384"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25 CRANBERRY ST STE A",
            "city": "RIVERHEAD",
            "state": "NY",
            "postal_code": "119012762",
            "telephone_number": "631-740-9384"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "79 Middleville Rd",
            "address_2": "Optometry 123",
            "address_purpose": "LOCATION",
            "city": "Northport",
            "state": "NY",
            "postal_code": "117682200",
            "country_code": "US",
            "telephone_number": "631-261-4400 x2038",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LICAUSI",
        "first_name": "JESSICA",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-07-26",
        "last_updated": "2019-08-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NY",
            "license": "TUV007703-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JESSICA",
            "last_name": "FULMER",
            "prefix": "DR.",
            "credential": "O.D.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Optometrist in Riverhead, NY
• Providers in Riverhead, NY by specialty
• Optometrist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2019; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.