Active NPI
Stuart Podell, O.D.
- Optometrist
- Commack, NY
National Provider Identifier
1366424442
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- TUV003125-1
- Practice address
- 77 Veterans Memorial Hwy
Commack, NY 11725-3410 - Phone
- (631) 499-8811
- Fax
- (631) 499-8846
- NPI assigned
- Nov 15, 2005
- 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 |
|---|---|---|---|---|
| Optometrist | 152W00000X | TUV003125-1 | NY | Primary |
Addresses
Primary practice location
77 Veterans Memorial Hwy
Commack, NY 11725-3410
Mailing address
77 Veterans Memorial Hwy
Commack, NY 11725-3410
Phone (631) 499-8811
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 4249551 | Other | NY | AETNA |
| P677306 | Other | NY | OXFORD |
| 0071420 | Other | NY | GHI |
| 00330290 | Medicaid | NY |
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| TUV003125-1 | NY | MD | Optometrist |
| 031251 | NY | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1132012800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1306368000000",
"number": "1366424442",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "77 VETERANS MEMORIAL HWY",
"city": "COMMACK",
"state": "NY",
"postal_code": "117253410",
"telephone_number": "631-499-8811",
"fax_number": "631-499-8846"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "77 VETERANS MEMORIAL HWY",
"city": "COMMACK",
"state": "NY",
"postal_code": "117253410",
"telephone_number": "631-499-8811",
"fax_number": "631-499-8846"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PODELL",
"first_name": "STUART",
"name_prefix": "Dr.",
"credential": "O.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-11-15",
"last_updated": "2011-05-26",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "NY",
"license": "TUV003125-1",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "4249551",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "OXFORD",
"identifier": "P677306",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "GHI",
"identifier": "0071420",
"state": "NY"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00330290",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Commack, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 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.