Active NPI
Mark F Kapusta, OD
- Optometrist
- Willoughby, OH
National Provider Identifier
1558438580
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 3511T508
- Practice address
- 30851 Euclid Ave
Suite 4
Willoughby, OH 44094 - Phone
- (440) 944-5155
- Fax
- (440) 943-9460
- NPI assigned
- Nov 28, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 3511T508 | OH | Primary |
Addresses
Primary practice location
30851 Euclid Ave
Suite 4
Willoughby, OH 44094
Mailing address
30851 Euclid Ave
Suite 4
Willoughby, OH 44094
Phone (440) 944-5155
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0474259 | Medicaid | OH |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3511T508 | OH | MD | Optometrist |
| 3511 | OH | MD | Hearing Instrument Specialist |
Interoperability endpoints
- mark.kapusta@uprisedirect.com
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1164672000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1354752000000",
"number": "1558438580",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "30851 EUCLID AVE",
"address_2": "SUITE 4",
"city": "WILLOUGHBY",
"state": "OH",
"postal_code": "44094",
"telephone_number": "440-944-5155",
"fax_number": "440-943-9460"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "30851 EUCLID AVE",
"address_2": "SUITE 4",
"city": "WILLOUGHBY",
"state": "OH",
"postal_code": "44094",
"telephone_number": "440-944-5155",
"fax_number": "440-943-9460"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KAPUSTA",
"first_name": "MARK",
"middle_name": "F",
"name_prefix": "Dr.",
"credential": "OD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-11-28",
"last_updated": "2012-12-06",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "OH",
"license": "3511T508",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0474259",
"state": "OH"
}
],
"endpoints": [],
"other_names": []
}Other providers in Willoughby, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 6, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.