Individual provider Active NPI

Bryan Michael Wolynski, O.D.

  • Optometrist
  • Jamaica, NY
National Provider Identifier
1619076346
Registry record updated May 8, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
TUV006289-1 Issued in NY
Practice address
9704 Sutphin Blvd
Jamaica, NY 11435-4721
Phone
(718) 657-7088
Fax
(718) 657-7092
NPI assigned
Sep 21, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 8, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X OPC 3623 FL
Optometrist 152W00000X TUV006289-1 NY Primary

Addresses

Primary practice location

9704 Sutphin Blvd
Jamaica, NY 11435-4721

Mailing address

60 Madison Ave FL 5
New York, NY 10010-1600
Phone (212) 545-2400

Other identifiers 1

IdentifierTypeStateIssuer
02531822MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040419001771 NY Practitioner - Optometry 6204821010 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
006289NYMDMental Health Counselor
OPC 3623FLMDOptometrist
TUV006289-1NYMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
State of New York Comptrollers Office CurrentSince Jan 22, 2020 Accepting new patients
State of New York Comptrollers Office Optometrist CurrentSince Jan 22, 2020 Accepting new patients
Nova Southeastern University, Inc Past Accepting new patients
Mark Fromer, MD PC PastSince Oct 3, 2003 Accepting new patients

Locations

33 W 42nd St
Fl 10
New York, NY 10036
Phone (212) 780-4930

University Eye Ctr
New York, NY 10087

Interoperability endpoints

  • Direct secure messaging: bryan.wolysnki.p1@direct.opt.nextgenshare.com

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1158796800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1557273600000",
    "number": "1619076346",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "60 MADISON AVE FL 5",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100101600",
            "telephone_number": "212-545-2400",
            "fax_number": "646-312-0481"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9704 SUTPHIN BLVD",
            "city": "JAMAICA",
            "state": "NY",
            "postal_code": "114354721",
            "telephone_number": "718-657-7088",
            "fax_number": "718-657-7092"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WOLYNSKI",
        "first_name": "BRYAN",
        "middle_name": "MICHAEL",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-21",
        "last_updated": "2019-05-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "FL",
            "license": "OPC 3623",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NY",
            "license": "TUV006289-1",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02531822",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Jamaica, NY

Sources for this page

Verify at the official NPI Registry.