NPIMap

Organization Active NPI

Kingsbridge Optometric Eye Care P.C.

  • Optometrist
  • Bronx, NY
National Provider Identifier
1487637500
Registry record updated Nov 18, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
Legal business name
KINGSBRIDGE OPTOMETRIC EYE CARE P.C.
Practice address
103 W Kingsbridge Rd
Bronx, NY 10468-3902
Phone
(718) 432-5555
Fax
(718) 548-2399
NPI assigned
Nov 22, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 18, 2010

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

Authorized official

Name
Dr. Peter S Bae, O.D.
Title
President
Phone
(718) 432-5555

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X Primary

Addresses

Primary practice location

103 W Kingsbridge Rd
Bronx, NY 10468-3902

Mailing address

103 W Kingsbridge Rd
Bronx, NY 10468-3902
Phone (718) 432-5555

Other identifiers 1

IdentifierTypeStateIssuer
02632864MedicaidNY

Other names 1

  • kingsbridge eye center Doing business as

National Provider Directory

National Provider Directory

Locations

103 W Kingsbridge Rd
Bronx, NY 10468
Phone (718) 432-5555

Practitioners & affiliated clinicians

Practitioners 4

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": "1132617600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1290038400000",
    "number": "1487637500",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "103 W KINGSBRIDGE RD",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104683902",
            "telephone_number": "718-432-5555"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "103 W KINGSBRIDGE RD",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104683902",
            "telephone_number": "718-432-5555",
            "fax_number": "718-548-2399"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KINGSBRIDGE OPTOMETRIC EYE CARE P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-11-22",
        "last_updated": "2010-11-18",
        "status": "A",
        "authorized_official_last_name": "BAE",
        "authorized_official_first_name": "PETER",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "718-432-5555",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02632864",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "kingsbridge eye center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bronx, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 18, 2010; 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.