Individual provider Active NPI

Ernest E. Sisneros Jr., O.D.

  • Optometrist
  • Montgomery, AL
National Provider Identifier
1619942612
Registry record updated Mar 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
S-B01-TA-673 Issued in AL
Practice address
2550 Eastern Blvd
Montgomery, AL 36117-1500
Phone
(334) 274-2020
Fax
(334) 396-9924
NPI assigned
Feb 22, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 7, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X S-B01-TA-673 AL Primary

Addresses

Primary practice location

2550 Eastern Blvd
Montgomery, AL 36117-1500

Mailing address

1950 Old Gallows Rd Ste 520
Vienna, VA 22182-3970
Phone (703) 847-8899

Other identifiers 1

IdentifierTypeStateIssuer
S-B01-TA-673OtherALAL BOARD OF OPTOMETRY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AL, NY, GA3 enrollments
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 3

Enrollment IDStateProvider typePAC IDDetails
I20050615000695 AL Practitioner - Optometry 2163466657 Reassigns benefits to 1 organization
I20131226000047 NY Practitioner - Optometry 2163466657 Reassigns benefits to 1 organization
I20180725002307 GA Practitioner - Optometry 2163466657 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
S-B01-TA-673ALMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Ga Doctors of Optometry LLC Optometrist CurrentSince Jul 14, 2022 Accepting new patients
Empire Vision Center Inc Optometrist CurrentSince Dec 1, 2013 Accepting new patients
Myeyedr Optometry of Alabama, LLC Optometrist CurrentSince May 14, 2018 Accepting new patients
Ga Doctors of Optometry LLC Optometrist CurrentSince Jul 14, 2022 Accepting new patients
Myeyedr Optometry of Alabama LLC Optometrist CurrentSince May 14, 2018 Accepting new patients
Myeyedr Optometry of Alabama LLC Optometrist Current Accepting new patients
Empire Vision Center, Inc CurrentSince Dec 1, 2013 Accepting new patients
Empire Vision Center Inc Optometrist Past Accepting new patients

Locations

3431 Colonnade Pkwy
Ste 100
Birmingham, AL 35243
Phone (205) 967-2020

2550 Eastern Blvd
Montgomery, AL 36117
Phone (334) 274-2020

50 Main Street Market Pl SE
Ste 100
Cartersville, GA 30121
Phone (770) 382-6379

2929 Turner Hill Rd
Ste 2625
Lithonia, GA 30038
Phone (770) 482-5050

560 Troy Schenectady Rd
#7
Latham, NY 12110
Phone (518) 783-0090

110 Consumer Sq
Plattsburgh, NY 12901
Phone (518) 562-0200

1950 Old Gallows Rd
Ste 520
Vienna, VA 22182

8614 Westwood Center Dr
Fl 9
Vienna, VA 22182

Organizations & group practices 8

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": "1140566400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1619942612",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1950 OLD GALLOWS RD STE 520",
            "city": "VIENNA",
            "state": "VA",
            "postal_code": "221823970",
            "telephone_number": "703-847-8899",
            "fax_number": "571-223-6780"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2550 EASTERN BLVD",
            "city": "MONTGOMERY",
            "state": "AL",
            "postal_code": "361171500",
            "telephone_number": "334-274-2020",
            "fax_number": "334-396-9924"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SISNEROS",
        "first_name": "ERNEST",
        "middle_name": "E.",
        "name_suffix": "Jr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-22",
        "last_updated": "2023-03-07",
        "certification_date": "2020-10-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "AL",
            "license": "S-B01-TA-673",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AL BOARD OF OPTOMETRY",
            "identifier": "S-B01-TA-673",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Montgomery, AL

Sources for this page

Verify at the official NPI Registry.