Individual provider Active NPI

Nerry Lex Nayzov, O.D.

  • Optometrist
  • Oakland Gardens, NY
National Provider Identifier
1467767970
Registry record updated Aug 23, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
TUV007580 Issued in NY
Practice address
21519 73Rd Ave
Oakland Gardens, NY 11364-2928
Phone
(718) 819-8477
Fax
(718) 819-8534
NPI assigned
Aug 10, 2010
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 23, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X TUV007580 NY Primary

Addresses

Primary practice location

21519 73Rd Ave
Oakland Gardens, NY 11364-2928

Mailing address

21519 73Rd Ave
Oakland Gardens, NY 11364-2928
Phone (718) 819-8477

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
I20201119001207 NY Practitioner - Optometry 5799025557 Reassigns benefits to 5 organizations

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Pennsylvania College of Optometry, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Haidatov Optometry PCGroup PAC ID 8224418256, 2 clinicians

Practice addresses (Care Compare)

21519 73Rd Ave
Oakland Gardens, NY 11364-2928
Phone (718) 483-6624

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
TUV007580NYMDOptometrist
007580NYMDOccupational Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Haidatov Optometry PC Optometrist CurrentSince Jun 1, 2022 Accepting new patients
Family Optical Shoppe Corp PastSince Oct 1, 2020 Accepting new patients

Locations

21519 73rd Ave
Oakland Gardens, NY 11364
Phone (347) 235-4999

Organizations & group practices 6

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": "1281398400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1692748800000",
    "number": "1467767970",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21519 73RD AVE",
            "city": "OAKLAND GARDENS",
            "state": "NY",
            "postal_code": "113642928",
            "telephone_number": "718-819-8477",
            "fax_number": "718-819-8534"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21519 73RD AVE",
            "city": "OAKLAND GARDENS",
            "state": "NY",
            "postal_code": "113642928",
            "telephone_number": "718-819-8477",
            "fax_number": "718-819-8534"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NAYZOV",
        "first_name": "NERRY",
        "middle_name": "LEX",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-08-10",
        "last_updated": "2023-08-23",
        "certification_date": "2023-08-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NY",
            "license": "TUV007580",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Oakland Gardens, NY

Sources for this page

Verify at the official NPI Registry.