NPIMap

Organization Active NPI

DRS Sandra M Krokos & Thomas P Kislan PC

  • Optometrist
  • Tannersville, PA
National Provider Identifier
1487784005
Registry record updated Mar 12, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
OE-000090 Issued in PA
Legal business name
DRS SANDRA M KROKOS & THOMAS P KISLAN PC
Practice address
2942 Route 611 Ste 105
Tannersville, PA 18372-7924
Phone
(570) 421-3342
Fax
(570) 421-8490
NPI assigned
Mar 6, 2007
Last updated
Mar 12, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 12, 2024

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

Authorized official

Name
Dr. Thomas P Kislan, O.D.NPI 1255319646
Title
Medical Director
Phone
(570) 421-3342

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 OE-000090 PA Primary

Addresses

Primary practice location

2942 Route 611 Ste 105
Tannersville, PA 18372-7924

Mailing address

2942 Route 611 Ste 105
Tannersville, PA 18372-7924
Phone (570) 421-3342

Other names 1

  • STROUDSBURG EYE SPECIALISTS Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040426000070 PA Part B Supplier - Clinic/Group Practice 6406842202 Receives reassigned benefits from 13 practitioners
4 other NPIs on this enrollment
Practice locations: Bangor, PA; Hazletownship, PA; Nanticoke, PA; Pottsville, PA; Tannersville, PA
O20100930008868 PA DME Supplier - Physician - OptometristDME Supplier - Optician 6406842202 Practice locations: Tannersville, PA

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 4

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
39D2057516Stroudsburg Eye Specialists2942 Route 611, Suite 105, Tannersville, PA 18372Certificate of waiverMar 25, 2028

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Stroudsburg Eye Specialists2942 Route 611, Tannersville, PA 18372-7924(570) 421-3342 Prosthetic Lenses: Conventional Eyeglasses|Prosthetic Lenses: Conventional Contact Lenses|Prosthetic Lenses: Prosthetics Cataract Lenses Accepts assignmentParticipating since Oct 1, 2001

National Provider Directory

National Provider Directory
Tax ID family
Dr Sandra M Krokos Thomas4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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

Locations

385 Bangor Junction Rd
Bangor, PA 18013
Phone (610) 588-0129

245 S Prospect St
Nanticoke, PA 18634
Phone (570) 580-4084

2942 Route 611
Ste 105
Tannersville, PA 18372
Phone (570) 421-3342

Practitioners & affiliated clinicians

Practitioners 13

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1173139200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1710201600000",
    "number": "1487784005",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2942 ROUTE 611 STE 105",
            "city": "TANNERSVILLE",
            "state": "PA",
            "postal_code": "183727924",
            "telephone_number": "570-421-3342",
            "fax_number": "570-421-8490"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2942 ROUTE 611 STE 105",
            "city": "TANNERSVILLE",
            "state": "PA",
            "postal_code": "183727924",
            "telephone_number": "570-421-3342",
            "fax_number": "570-421-8490"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DRS SANDRA M KROKOS & THOMAS P KISLAN PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-06",
        "last_updated": "2024-03-12",
        "certification_date": "2022-03-10",
        "status": "A",
        "authorized_official_last_name": "KISLAN",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "570-421-3342",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "PA",
            "license": "OE-000090",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "STROUDSBURG EYE SPECIALISTS",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Tannersville, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 12, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.