NPIMap

Organization Active NPI

Watertown Medical Optical PLLC

  • Eyewear Supplier
  • Gouverneur, NY
National Provider Identifier
1407319155
Registry record updated Apr 10, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Eyewear SupplierTaxonomy code 332H00000X
Legal business name
WATERTOWN MEDICAL OPTICAL PLLC
Practice address
77 W Barney St Ste F
Gouverneur, NY 13642-1040
Phone
(315) 287-3638
Fax
(315) 287-3656
NPI assigned
Apr 10, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 10, 2019

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

Authorized official

Name
Mrs. Doris Prashaw, OPTHALMIC DISPENSER
Title
Manager
Phone
(315) 393-7171

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X
Eyewear Supplier 332H00000X Primary

Addresses

Primary practice location

77 W Barney St Ste F
Gouverneur, NY 13642-1040

Mailing address

77 W Barney St Ste F
Gouverneur, NY 13642-1040
Phone (315) 287-3638

Other names 1

  • NOAMAN SANNI MD Other name

National Provider Directory

National Provider Directory
Tax ID family
Watertown Medical Optical PLLC3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

Locations

77 W Barney St
Ste F
Gouverneur, NY 13642
Phone (315) 287-3638

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1554854400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1554854400000",
    "number": "1407319155",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "77 W BARNEY ST STE F",
            "city": "GOUVERNEUR",
            "state": "NY",
            "postal_code": "136421040",
            "telephone_number": "315-287-3638",
            "fax_number": "315-287-3656"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "77 W BARNEY ST STE F",
            "city": "GOUVERNEUR",
            "state": "NY",
            "postal_code": "136421040",
            "telephone_number": "315-287-3638",
            "fax_number": "315-287-3656"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WATERTOWN MEDICAL OPTICAL PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-04-10",
        "last_updated": "2019-04-10",
        "status": "A",
        "authorized_official_last_name": "PRASHAW",
        "authorized_official_first_name": "DORIS",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "315-393-7171",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "OPTHALMIC DISPENSER"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "332H00000X",
            "taxonomy_group": "",
            "desc": "Eyewear Supplier",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "NOAMAN SANNI MD",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Gouverneur, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 10, 2019; 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.