NPIMap

Organization Active NPI

SVC of Manhasset LLC

  • Optometrist
  • Manhasset, NY
National Provider Identifier
1366059172
Registry record updated Sep 25, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
Legal business name
SVC OF MANHASSET LLC
Practice address
433 Plandome Rd
Manhasset, NY 11030-1942
Phone
(516) 627-0208
Fax
(516) 627-2929
NPI assigned
Sep 25, 2020
Last updated
Sep 25, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 25, 2020

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

Authorized official

Name
Mr. Jeffrey S Williams Jr., OD
Title
Authorized Official / Owner
Phone
(631) 422-2442

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X Primary
Eyewear Supplier 332H00000X

Addresses

Primary practice location

433 Plandome Rd
Manhasset, NY 11030-1942

Mailing address

887 Old Country Rd Ste GKL
Riverhead, NY 11901-2115
Phone (631) 727-2858

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210311000102 NY Part B Supplier - Clinic/Group Practice 4486060753 Receives reassigned benefits from 12 practitioners
Practice locations: Manhasset, NY

National Provider Directory

National Provider Directory

Locations

433 Plandome Rd
Plandome, NY 11030
Phone (516) 627-0208

Practitioners & affiliated clinicians

Practitioners 12

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1600992000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1600992000000",
    "number": "1366059172",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "887 OLD COUNTRY RD STE GKL",
            "city": "RIVERHEAD",
            "state": "NY",
            "postal_code": "119012115",
            "telephone_number": "631-727-2858",
            "fax_number": "631-727-2866"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "433 PLANDOME RD",
            "city": "MANHASSET",
            "state": "NY",
            "postal_code": "110301942",
            "telephone_number": "516-627-0208",
            "fax_number": "516-627-2929"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SVC OF MANHASSET LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-09-25",
        "last_updated": "2020-09-25",
        "certification_date": "2020-09-25",
        "status": "A",
        "authorized_official_last_name": "WILLIAMS",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "AUTHORIZED OFFICIAL / OWNER",
        "authorized_official_telephone_number": "631-422-2442",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "332H00000X",
            "taxonomy_group": "",
            "desc": "Eyewear Supplier",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Manhasset, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 25, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.