Individual provider Active NPI

Dawn Louise Pisello, O.D.

  • Optometrist
  • Canandaigua, NY
National Provider Identifier
1386647154
Registry record updated Sep 29, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
005497 Issued in NY
Practice address
325 West St
Canandaigua, NY 14424-1723
Phone
(585) 394-2020
Fax
(585) 394-9261
NPI assigned
May 24, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 29, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 005497 NY Primary

Addresses

Primary practice location

325 West St
Canandaigua, NY 14424-1723

Mailing address

274 W Main St
Victor, NY 14564-1157
Phone (585) 924-4430

Other identifiers 1

IdentifierTypeStateIssuer
01627430MedicaidNY

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
I20100329000179 NY Practitioner - Optometry 8729114822 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Pennsylvania College of Optometry, 1993
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
C and R Vision Center IncGroup PAC ID 3274592167, 4 clinicians

Practice addresses (Care Compare)

274 W Main St
Victor, NY 14564-1157
Phone (585) 924-4430

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
005497NYMDClinical Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
C & R Vision Center Inc CurrentSince Aug 31, 2016 Accepting new patients
Arnold Larry Shapiro Past Accepting new patients

Locations

274 W Main St
Victor, NY 14564
Phone (585) 924-3250

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1116892800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1475107200000",
    "number": "1386647154",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "274 W MAIN ST",
            "city": "VICTOR",
            "state": "NY",
            "postal_code": "145641157",
            "telephone_number": "585-924-4430"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "325 WEST ST",
            "city": "CANANDAIGUA",
            "state": "NY",
            "postal_code": "144241723",
            "telephone_number": "585-394-2020",
            "fax_number": "585-394-9261"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PISELLO",
        "first_name": "DAWN",
        "middle_name": "LOUISE",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-05-24",
        "last_updated": "2016-09-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NY",
            "license": "005497",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01627430",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Canandaigua, NY

Sources for this page

Verify at the official NPI Registry.