Individual provider Active NPI

Vladimir Dvoretsky, O.D.

  • Optometrist
  • New York, NY
National Provider Identifier
1336294636
Registry record updated Aug 12, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
007109 Issued in NY
Practice address
817 W 181St St
New York, NY 10033-4516
Phone
(212) 923-2020
NPI assigned
Jan 24, 2007
Last updated
Aug 12, 2011By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 12, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 007109 NY Primary

Addresses

Primary practice location

817 W 181St St
New York, NY 10033-4516

Mailing address

817 W 181St St
New York, NY 10033-4516
Phone (212) 923-2020

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
I20071024000387 NY Practitioner - Optometry 5193812097 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Other, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Vistasite Vision Center Inc.Group PAC ID 2062806839, 2 clinicians
Vista Optometry and Ophthalmic Dispensing Care PLLCGroup PAC ID 9032216825, 2 clinicians

Practice addresses (Care Compare)

4204 Broadway
New York, NY 10033-3706
Phone (917) 261-6100

665 W 181St St
New York, NY 10033-3877
Phone (212) 927-1000

817 W 181St St
New York, NY 10033-4516
Phone (212) 923-2020

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Vista Optometry and Ophthalmic Dispensing Care PLLC Optometrist CurrentSince Jul 27, 2011 Accepting new patients
Vistasite Optique Inc CurrentSince Feb 23, 2019 Accepting new patients
Vistasite Vision Center Inc. Optometrist CurrentSince Jan 27, 2022 Accepting new patients
Sight N Style Optical Optometrist PastSince Jan 27, 2022 Accepting new patients

Locations

4204 Broadway
New York, NY 10033
Phone (917) 261-6100

665 W 181st St
New York, NY 10033
Phone (212) 927-1000

817 W 181st St
New York, NY 10033
Phone (212) 257-3308

Organizations & group practices 4

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": "1169596800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1313107200000",
    "number": "1336294636",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "817 W 181ST ST",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100334516",
            "telephone_number": "212-923-2020"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "817 W 181ST ST",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100334516",
            "telephone_number": "212-923-2020"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DVORETSKY",
        "first_name": "VLADIMIR",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-24",
        "last_updated": "2011-08-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NY",
            "license": "007109",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New York, NY

Sources for this page

Verify at the official NPI Registry.