NPIMap

Organization Active NPI

SVC of Coram LLC

  • Optometrist
  • Medford, NY
National Provider Identifier
1619411972
Registry record updated Jul 28, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
Legal business name
SVC OF CORAM LLC
Practice address
1721 N Ocean Ave Ste a
Medford, NY 11763-2684
Phone
(631) 732-0822
Fax
(631) 732-0018
NPI assigned
Dec 6, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 28, 2022

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

Authorized official

Name
Jeffrey S Williams Jr., OD
Title
Owner
Phone
(631) 727-7858

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X Primary
Eyewear Supplier 332H00000X

Addresses

Primary practice location

1721 N Ocean Ave Ste a
Medford, NY 11763-2684

Mailing address

1224 Ostrander Avenue
Riverhead, NY 11901
Phone (631) 727-2858

Other names 1

  • Sound Vision Care Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200327001175 NY Part B Supplier - Clinic/Group Practice 8426487315 Receives reassigned benefits from 4 practitioners
Practice locations: Medford, NY

National Provider Directory

National Provider Directory
Tax ID family
Sound Vision Care Inc3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

Locations

1721 N Ocean Ave
Medford, NY 11763

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1480982400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658966400000",
    "number": "1619411972",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1224 OSTRANDER AVENUE",
            "city": "RIVERHEAD",
            "state": "NY",
            "postal_code": "11901",
            "telephone_number": "631-727-2858",
            "fax_number": "631-727-2866"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1721 N OCEAN AVE STE A",
            "city": "MEDFORD",
            "state": "NY",
            "postal_code": "117632684",
            "telephone_number": "631-732-0822",
            "fax_number": "631-732-0018"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SVC OF CORAM LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-12-06",
        "last_updated": "2022-07-28",
        "certification_date": "2022-07-28",
        "status": "A",
        "authorized_official_last_name": "WILLIAMS",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "631-727-7858",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "332H00000X",
            "taxonomy_group": "",
            "desc": "Eyewear Supplier",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Sound Vision Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Medford, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 28, 2022; 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.