Active NPI
Oleg Petrogalis
- Optician
- Valley Stream, NY
National Provider Identifier
1568978336
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optician
- License
- 6702
- Practice address
- 77 Green Acres Rd
Valley Stream, NY 11581-1008 - Phone
- (516) 612-0528
- Fax
- (516) 887-2565
- NPI assigned
- Dec 15, 2017
- 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 |
|---|---|---|---|---|
| Optician | 156FX1800X | 6702 | NY | Primary |
Addresses
Primary practice location
77 Green Acres Rd
Valley Stream, NY 11581-1008
Mailing address
77 Green Acres Rd
Valley Stream, NY 11581-1008
Phone (516) 612-0528
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0710862119 | Medicaid | NY |
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)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1513296000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1513296000000",
"number": "1568978336",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "77 GREEN ACRES RD",
"city": "VALLEY STREAM",
"state": "NY",
"postal_code": "115811008",
"telephone_number": "516-612-0528",
"fax_number": "516-887-2565"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "77 GREEN ACRES RD",
"city": "VALLEY STREAM",
"state": "NY",
"postal_code": "115811008",
"telephone_number": "516-612-0528",
"fax_number": "516-887-2565"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETROGALIS",
"first_name": "OLEG",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2017-12-15",
"last_updated": "2017-12-15",
"status": "A"
},
"taxonomies": [
{
"code": "156FX1800X",
"taxonomy_group": "",
"desc": "Technician/Technologist, Optician",
"state": "NY",
"license": "6702",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0710862119",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Valley Stream, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 15, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.