Diana Ilyasova, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

TUV007417 Issued in NY

Practice address

731 Lydig Ave
Bronx, NY 10462-2103

Phone

(718) 829-2160

Fax

(718) 829-9502

NPI assigned

Sep 23, 2009

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

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

Specialty

Optometry

Education

State University of New York - State College Optometry, 2009

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Pelham Parkway Vision Center IncGroup PAC ID 6305938218, 4 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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

• Pelham Parkway Vision Center Inc

  • Vision Therapy Optometrist
  • Bronx, NY
  • NPI 1740402205
  Medicare reassignment Care Compare group NPD
• Leading Optometry, P.C.

  • Optometrist
  • Fresh Meadows, NY
  • NPI 1306179775
  NPD (past) Authorized official

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

{
    "created_epoch": "1253664000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1615939200000",
    "number": "1629302658",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7511 169TH ST",
            "city": "FRESH MEADOWS",
            "state": "NY",
            "postal_code": "113661337"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "731 LYDIG AVE",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104622103",
            "telephone_number": "718-829-2160",
            "fax_number": "718-829-9502"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ILYASOVA",
        "first_name": "DIANA",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2009-09-23",
        "last_updated": "2021-03-17",
        "certification_date": "2021-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NY",
            "license": "TUV007417",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3185751",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Victoria Ilori
• Omer Ilus, DMD
• Shaharyar Ilyas
• Sobia Ilyas
• Suleman Ilyas, MD
• Inna Ilyasova
• Ella Ilyayeva, RPH
• Ester Ilyayeva, M.D.
• Igor Ilyazarov
• David Im, RN

• Optometrist in Bronx, NY
• Providers in Bronx, NY by specialty
• Optometrist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.