Wavecrest Optical Shop

Primary specialty

OptometristTaxonomy code 152W00000X

License

005665 Issued in NY

Legal business name

WAVECREST OPTICAL SHOP

Practice address

257 Beach 20TH St
Far Rockaway, NY 11691-3625

Phone

(718) 327-2020

Fax

(718) 327-3429

NPI assigned

May 30, 2007

Organization subpart

No

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

Authorized official

Name

Barry Raines

Title

Owner

Phone

(718) 327-2020

Specialties & licenses 1

Addresses

Other identifiers 1

Tax ID family

Barry Scott Raines2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Barry Scott Raines

  dba Wavecrest Optical Shop

  • Eyewear Supplier
  • Far Rockaway, NY
  • NPI 1942285721
  NPD tax ID

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

{
    "created_epoch": "1180483200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1187222400000",
    "number": "1407057136",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "257 BEACH 20TH ST",
            "city": "FAR ROCKAWAY",
            "state": "NY",
            "postal_code": "116913625",
            "telephone_number": "718-327-2020",
            "fax_number": "718-327-3429"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "257 BEACH 20TH ST",
            "city": "FAR ROCKAWAY",
            "state": "NY",
            "postal_code": "116913625",
            "telephone_number": "718-327-2020",
            "fax_number": "718-327-3429"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WAVECREST OPTICAL SHOP",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-30",
        "last_updated": "2007-08-16",
        "status": "A",
        "authorized_official_last_name": "RAINES",
        "authorized_official_first_name": "BARRY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "718-327-2020"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "NY",
            "license": "005665",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01136483",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Rivka Leah Warga, LMSW
• Itisha Washington, NP
• Shareece Washington
• Wavecrest Home for Adults
• Wavecrest Homecare
• Loretta Weaver, LPN
• Andrea Weberman
• Guan Jie Wee, MD
• Benjamin Samuel Weil, RDN, RD, CDN
• Aliza Weiner

• Optometrist in Far Rockaway, NY
• Providers in Far Rockaway, NY by specialty
• Optometrist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 16, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.