Medplaza Optical Inc

Primary specialty

OptometristTaxonomy code 152W00000X

License

VUT006567 Issued in NY

Legal business name

MEDPLAZA OPTICAL INC

Practice address

3065 Brighton 14TH St
Brooklyn, NY 11235-5501

Phone

(718) 332-5047

NPI assigned

Jun 14, 2006

Last updated

Nov 23, 2007By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Alexander KovbasyukNPI 1972754109

Title

President

Phone

(718) 332-5047

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

Practitioners 2

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.

• Ella Gelb, OD

  • Optometrist
  • Brooklyn, NY
  • NPI 1467432195
  Medicare reassignment NPD
• Alexander Kovbasyuk, ETC

  • Optician
  • Brooklyn, NY
  • NPI 1972754109
  Authorized official Same address or phone

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

{
    "created_epoch": "1150243200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1195776000000",
    "number": "1568405629",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3065 BRIGHTON 14TH ST",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112355501",
            "telephone_number": "718-332-5047"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3065 BRIGHTON 14TH ST",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112355501",
            "telephone_number": "718-332-5047"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDPLAZA OPTICAL INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-14",
        "last_updated": "2007-11-23",
        "status": "A",
        "authorized_official_last_name": "KOVBASYUK",
        "authorized_official_first_name": "ALEXANDER",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "718-332-5047"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NY",
            "license": "VUT006567",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02409043",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Roslyn Medoff-Rivera, LPN
• Marie Yves Medor, LPN
• Inna Medow, LICENSED OPTICIAN
• Marsha Ellen Medows, M.D.
• Medpack LLC
• Medpro Homecare Agency, Inc
• Medpro Mobile Services LLC
• Medpro Pharmacy
• Medprom Inc
• Lauro F Medrano-Saldana, DDS

• Optometrist in Brooklyn, NY
• Providers in Brooklyn, NY by specialty
• Optometrist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 23, 2007; 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.