Nickolas J Shissias, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

27OA00657600 Issued in NJ

Practice address

204 Haddon Ave
West Berlin, NJ 08091-1607

Phone

(856) 768-2515

Fax

(856) 768-7451

NPI assigned

Jun 16, 2013

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in DE, NJ2 enrollments

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 2

Specialty

Optometry

Education

Pennsylvania College of Optometry, 2013

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

SNS VisionGroup PAC ID 9335539600, 3 clinicians

Personaleyes Vision Group, LLCGroup PAC ID 5496111650, 2 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: nickolas.shissiasod.p1@direct.horizoneyecare.nextgenshare.com

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.

• Personaleyes Vision Group LLC

  • Optometrist
  • Runnemede, NJ
  • NPI 1700584000
  Medicare reassignment Care Compare group NPD
• SNS Vision

  • Optometrist
  • West Berlin, NJ
  • NPI 1750053450
  Medicare reassignment Care Compare group NPD
• Simon Eye Associates PA

  • Optometrist
  • Wilmington, DE
  • NPI 1205871506
  Medicare reassignment NPD

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

{
    "created_epoch": "1371340800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1707436800000",
    "number": "1346689080",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "204 HADDON AVE",
            "city": "WEST BERLIN",
            "state": "NJ",
            "postal_code": "080911607",
            "telephone_number": "856-768-2515",
            "fax_number": "856-768-7451"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "204 HADDON AVE",
            "city": "WEST BERLIN",
            "state": "NJ",
            "postal_code": "080911607",
            "telephone_number": "856-768-2515",
            "fax_number": "856-768-7451"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHISSIAS",
        "first_name": "NICKOLAS",
        "middle_name": "J",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2013-06-16",
        "last_updated": "2024-02-09",
        "certification_date": "2024-02-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "DE",
            "license": "14-0000066",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NJ",
            "license": "27OA00657600",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Corinne Leigh Rieser, PA-C
• Larry Sol Rosenberg, MD
• Theresa Mary Rosiak
• Sambulance Safety Squad
• Shivangi Shah, PHARMD
• Sara Shkalim Shissias, OD
• Sid III,LLC
• Ashima Sirpal, DMD
• SNS Vision
• Monica Jacquelyn Sparks, PHARMD

• Optometrist in West Berlin, NJ
• Providers in West Berlin, NJ by specialty
• Optometrist in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 9, 2024; 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.