Individual provider Active NPI

Robert J Ancona, O.D.

  • Optometrist
  • Brooklyn, NY
National Provider Identifier
1518946243
Registry record updated Sep 15, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
VUT 005837 Issued in NY
Practice address
84 Front St
Brooklyn, NY 11201-1004
Phone
(718) 422-7800
Fax
(718) 422-7887
NPI assigned
Jan 11, 2006
Last updated
Sep 15, 2009By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 15, 2009

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

Specialties & licenses 8

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X VUT 005837 NY Primary
Corneal and Contact Management Optometrist 152WC0802X VUT 005837 NY
Corneal and Contact Management Optometrist 152WC0802X TUV005837-1 NY
Low Vision Rehabilitation Optometrist 152WL0500X VUT 005837 NY
Pediatric Optometrist 152WP0200X VUT 005837 NY
Sports Vision Optometrist 152WS0006X VUT 005837 NY
Vision Therapy Optometrist 152WV0400X VUT 005837 NY
Occupational Vision Optometrist 152WX0102X VUT005837 NY

Addresses

Primary practice location

84 Front St
Brooklyn, NY 11201-1004

Mailing address

84 Front St
Brooklyn, NY 11201-1004
Phone (718) 422-7800

Other identifiers 1

IdentifierTypeStateIssuer
01956312MedicaidNY

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
I20040522000160 NY Practitioner - Optometry 1355332834 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
State University of New York - State College Optometry, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

84 Front St
Brooklyn, NY 11201-1004
Phone (718) 260-8900

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
TUV005837-1NYMDCorneal and Contact Management Optometrist
VUT 005837NYMDSports Vision Optometrist
VUT005837NYMDOccupational Vision Optometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Plaza Optical Centre, Inc PastSince Nov 16, 2016 Accepting new patients

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1136937600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1252972800000",
    "number": "1518946243",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "84 FRONT ST",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112011004",
            "telephone_number": "718-422-7800",
            "fax_number": "718-422-7887"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "84 FRONT ST",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112011004",
            "telephone_number": "718-422-7800",
            "fax_number": "718-422-7887"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANCONA",
        "first_name": "ROBERT",
        "middle_name": "J",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-11",
        "last_updated": "2009-09-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NY",
            "license": "VUT 005837",
            "primary": true
        },
        {
            "code": "152WC0802X",
            "taxonomy_group": "",
            "desc": "Optometrist, Corneal and Contact Management",
            "state": "NY",
            "license": "VUT 005837",
            "primary": false
        },
        {
            "code": "152WC0802X",
            "taxonomy_group": "",
            "desc": "Optometrist, Corneal and Contact Management",
            "state": "NY",
            "license": "TUV005837-1",
            "primary": false
        },
        {
            "code": "152WL0500X",
            "taxonomy_group": "",
            "desc": "Optometrist, Low Vision Rehabilitation",
            "state": "NY",
            "license": "VUT 005837",
            "primary": false
        },
        {
            "code": "152WP0200X",
            "taxonomy_group": "",
            "desc": "Optometrist, Pediatrics",
            "state": "NY",
            "license": "VUT 005837",
            "primary": false
        },
        {
            "code": "152WS0006X",
            "taxonomy_group": "",
            "desc": "Optometrist, Sports Vision",
            "state": "NY",
            "license": "VUT 005837",
            "primary": false
        },
        {
            "code": "152WV0400X",
            "taxonomy_group": "",
            "desc": "Optometrist, Vision Therapy",
            "state": "NY",
            "license": "VUT 005837",
            "primary": false
        },
        {
            "code": "152WX0102X",
            "taxonomy_group": "",
            "desc": "Optometrist, Occupational Vision",
            "state": "NY",
            "license": "VUT005837",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01956312",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Brooklyn, NY

Sources for this page

Verify at the official NPI Registry.