Individual provider Active NPI

Brian M Rodrigues, O.D.

  • Optometrist
  • Ossining, NY
National Provider Identifier
1407103344
Registry record updated Dec 30, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
007907 Issued in NY
Practice address
57 Croton Ave Ste 3
Ossining, NY 10562-4920
Phone
(914) 923-0300
Fax
(914) 923-0300
NPI assigned
Aug 9, 2012
Last updated
Dec 30, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 30, 2022

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 2903 CT
Optometrist 152W00000X 007907 NY Primary
Vision Therapy Optometrist 152WV0400X 007907 NY
Vision Therapy Optometrist 152WV0400X 2903 CT

Addresses

Primary practice location

57 Croton Ave Ste 3
Ossining, NY 10562-4920

Mailing address

57 Croton Ave Ste 3
Ossining, NY 10562-4920
Phone (914) 923-0300

Other practice location 1

933 Mamaroneck Ave
Ste 105
New York, NY 10543
Phone (914) 698-2182

Other identifiers 1

IdentifierTypeStateIssuer
03548634MedicaidNY

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
I20121018000059 NY Practitioner - Optometry 6901056498 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
State University of New York - State College Optometry, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

57 Croton Ave
Suite 3
Ossining, NY 10562-4920
Phone (914) 923-0300

57 Croton Ave
Suite 3
Ossining, NY 10562-4981

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
007907NYMDAcupuncturist
002903CTMDOccupational Therapist

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1344470400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1672358400000",
    "number": "1407103344",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "57 CROTON AVE STE 3",
            "city": "OSSINING",
            "state": "NY",
            "postal_code": "105624920",
            "telephone_number": "914-923-0300",
            "fax_number": "914-923-0450"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "57 CROTON AVE STE 3",
            "city": "OSSINING",
            "state": "NY",
            "postal_code": "105624920",
            "telephone_number": "914-923-0300",
            "fax_number": "914-923-0300"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "933 Mamaroneck Ave",
            "address_2": "Ste 105",
            "address_purpose": "LOCATION",
            "city": "New York",
            "state": "NY",
            "postal_code": "10543",
            "country_code": "US",
            "telephone_number": "914-698-2182",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RODRIGUES",
        "first_name": "BRIAN",
        "middle_name": "M",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-08-09",
        "last_updated": "2022-12-30",
        "certification_date": "2022-12-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CT",
            "license": "2903",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NY",
            "license": "007907",
            "primary": true
        },
        {
            "code": "152WV0400X",
            "taxonomy_group": "",
            "desc": "Optometrist, Vision Therapy",
            "state": "NY",
            "license": "007907",
            "primary": false
        },
        {
            "code": "152WV0400X",
            "taxonomy_group": "",
            "desc": "Optometrist, Vision Therapy",
            "state": "CT",
            "license": "2903",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03548634",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Ossining, NY

Sources for this page

Verify at the official NPI Registry.