NPIMap

Organization Active NPI

DRS Sandra M Krokos & Thomas P Kislan PC

Doing business as Bangor Eye Specialists

  • Optometrist
  • Tannersville, PA
National Provider Identifier
1609634799
Registry record updated Mar 12, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
Legal business name
DRS SANDRA M KROKOS & THOMAS P KISLAN PC
Doing business as
Bangor Eye Specialists
Practice address
2942 Route 611 Ste 105
Tannersville, PA 18372-7924
Phone
(570) 421-3342
NPI assigned
Mar 12, 2024
Last updated
Mar 12, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 12, 2024

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

Authorized official

Name
Leslie Williams
Title
Practice Manager
Phone
(570) 421-3342

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X NU Primary

Addresses

Primary practice location

2942 Route 611 Ste 105
Tannersville, PA 18372-7924

Mailing address

2942 Route 611 Ste 105
Tannersville, PA 18372-7924
Phone (570) 421-3342

Other names 1

  • Bangor Eye Specialists Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040426000070 PA Part B Supplier - Clinic/Group Practice 6406842202 Receives reassigned benefits from 13 practitioners
4 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Bangor, PA; Hazletownship, PA; Nanticoke, PA; Pottsville, PA; Tannersville, PA

Other NPIs on the same Medicare enrollment 4

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Dr Sandra M Krokos Thomas4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Locations

245 S Prospect St
Nanticoke, PA 18634
Phone (570) 580-4084

541 W Bacon St
Pottsville, PA 17901
Phone (570) 621-4800

2942 Route 611
Ste 105
Tannersville, PA 18372
Phone (570) 421-3342

2942 Route 611
Ste 5
Tannersville, PA 18372
Phone (570) 421-3342

Practitioners & affiliated clinicians

Practitioners 13

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.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1710201600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1710201600000",
    "number": "1609634799",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2942 ROUTE 611 STE 105",
            "city": "TANNERSVILLE",
            "state": "PA",
            "postal_code": "183727924",
            "telephone_number": "570-421-3342"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2942 ROUTE 611 STE 105",
            "city": "TANNERSVILLE",
            "state": "PA",
            "postal_code": "183727924",
            "telephone_number": "570-421-3342"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DRS SANDRA M KROKOS & THOMAS P KISLAN PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-03-12",
        "last_updated": "2024-03-12",
        "certification_date": "2024-03-12",
        "status": "A",
        "authorized_official_last_name": "WILLIAMS",
        "authorized_official_first_name": "LESLIE",
        "authorized_official_title_or_position": "PRACTICE MANAGER",
        "authorized_official_telephone_number": "570-421-3342"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bangor Eye Specialists",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Tannersville, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 12, 2024; 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.