NPIMap

Organization Active NPI

Brooke Plaza Optical, Inc.

Doing business as Plaza Optical

  • Optometrist
  • Oceanside, NY
National Provider Identifier
1467620708
Registry record updated May 19, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
VUT2830-1 Issued in NY
Legal business name
BROOKE PLAZA OPTICAL, INC.
Doing business as
Plaza Optical
Practice address
3450 Long Beach Rd
Oceanside, NY 11572-5440
Phone
(516) 678-1616
Fax
(516) 764-2711
NPI assigned
Feb 20, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 19, 2009

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

Authorized official

Name
Dr. Richard Bohn, ODNPI 1124163647
Title
President
Phone
(516) 678-1616

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X VUT2830-1 NY Primary

Addresses

Primary practice location

3450 Long Beach Rd
Oceanside, NY 11572-5440

Mailing address

3450 Long Beach Rd
Oceanside, NY 11572-5440
Phone (516) 678-1616

Other names 1

  • Plaza Optical Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090427000182 NY Part B Supplier - Clinic/Group Practice 3274681523 Receives reassigned benefits from 3 practitioners
Practice locations: Oceanside, NY

National Provider Directory

National Provider Directory

Locations

3450 Long Beach Rd
Oceanside, NY 11572
Phone (516) 678-1616

Practitioners & affiliated clinicians

Practitioners 5

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": "1203465600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1242691200000",
    "number": "1467620708",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3450 LONG BEACH RD",
            "city": "OCEANSIDE",
            "state": "NY",
            "postal_code": "115725440",
            "telephone_number": "516-678-1616",
            "fax_number": "516-764-2711"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3450 LONG BEACH RD",
            "city": "OCEANSIDE",
            "state": "NY",
            "postal_code": "115725440",
            "telephone_number": "516-678-1616",
            "fax_number": "516-764-2711"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BROOKE PLAZA OPTICAL, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-02-20",
        "last_updated": "2009-05-19",
        "status": "A",
        "authorized_official_last_name": "BOHN",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "516-678-1616",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "NY",
            "license": "VUT2830-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Plaza Optical",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Oceanside, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 19, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.