Organization Active NPI

Optic One Inc

  • Optometrist
  • Cinnaminson, NJ
National Provider Identifier
1558064386
Registry record updated Mar 22, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
Legal business name
OPTIC ONE INC
Practice address
2401 Route 130 S
Cinnaminson, NJ 08077-3020
Phone
(856) 786-1616
Fax
(856) 786-3565
NPI assigned
Mar 22, 2023
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 22, 2023

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

Authorized official

Name
Mr. Robert Dean Levy, DONPI 1861495517
Title
Owner
Phone
(856) 786-1616

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 Primary

Addresses

Primary practice location

2401 Route 130 S
Cinnaminson, NJ 08077-3020

Mailing address

4423 Route 130 S
Burlington, NJ 08016-2385
Phone (609) 386-0202

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20230501000011 NJ Part B Supplier - Clinic/Group Practice 5799140554 Receives reassigned benefits from 3 practitioners
Practice locations: Cinnaminson, NJ

National Provider Directory

National Provider Directory

Locations

2401 Route 130 S
Cinnaminson, NJ 08077
Phone (856) 786-1616

Practitioners & affiliated clinicians

Practitioners 3

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": "1679443200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1679443200000",
    "number": "1558064386",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4423 ROUTE 130 S",
            "city": "BURLINGTON",
            "state": "NJ",
            "postal_code": "080162385",
            "telephone_number": "609-386-0202",
            "fax_number": "609-386-5927"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2401 ROUTE 130 S",
            "city": "CINNAMINSON",
            "state": "NJ",
            "postal_code": "080773020",
            "telephone_number": "856-786-1616",
            "fax_number": "856-786-3565"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OPTIC ONE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-03-22",
        "last_updated": "2023-03-22",
        "certification_date": "2023-03-21",
        "status": "A",
        "authorized_official_last_name": "LEVY",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "DEAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "856-786-1616",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Cinnaminson, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 22, 2023; 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.