Active NPI
Raymond A Klark Jr., OPTICIAN
- Optician
- Tonawanda, NY
National Provider Identifier
1639292535
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optician
- License
- 4077
- Practice address
- 236 Pinewoods Ave
Tonawanda, NY 14150-7068 - Phone
- (716) 836-1909
- Fax
- (716) 434-7809
- NPI assigned
- Apr 8, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optician | 156FX1800X | 4077 | NY | Primary |
Addresses
Primary practice location
236 Pinewoods Ave
Tonawanda, NY 14150-7068
Mailing address
236 Pinewoods Ave
Tonawanda, NY 14150-7068
Phone (716) 836-1909
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00707231 | Medicaid | NY |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4077 | NY | MD | Optician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1175990400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183939200000",
"number": "1639292535",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "236 PINEWOODS AVE",
"city": "TONAWANDA",
"state": "NY",
"postal_code": "141507068",
"telephone_number": "716-836-1909",
"fax_number": "716-434-7809"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "236 PINEWOODS AVE",
"city": "TONAWANDA",
"state": "NY",
"postal_code": "141507068",
"telephone_number": "716-836-1909",
"fax_number": "716-434-7809"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KLARK",
"first_name": "RAYMOND",
"middle_name": "A",
"name_prefix": "Mr.",
"name_suffix": "Jr.",
"credential": "OPTICIAN",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-04-08",
"last_updated": "2007-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "156FX1800X",
"taxonomy_group": "",
"desc": "Technician/Technologist, Optician",
"state": "NY",
"license": "4077",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00707231",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Tonawanda, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.