Michael James McGovern, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

TUV5891 Issued in NY

Practice address

624 Hawkins Ave
Suite #1
Lake Ronkonkoma, NY 11779-2324

Phone

(631) 588-5100

NPI assigned

Jul 13, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

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

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: michael.mcgovern.p1@direct.opt.nextgenshare.com

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.

• State of New York Comptrollers Office

  dba Suny College of Optometry/University Eye Center

  • Optometrist
  • New York, NY
  • NPI 1407829856
  Medicare reassignment NPD Authorized official
• State of New York Comptrollers Office

  • Developmental Disabilities Clinic/Center
  • Staten Island, NY
  • NPI 1750469912
  NPD
• Suny Downstate Medical Center

  • Emergency Medicine Physician
  • Brooklyn, NY
  • NPI 1699704155
  NPD (past)

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

{
    "created_epoch": "1121212800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1210636800000",
    "number": "1669470530",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "624 HAWKINS AVE",
            "address_2": "SUITE 1",
            "city": "LAKE RONKONKOMA",
            "state": "NY",
            "postal_code": "117792324",
            "telephone_number": "631-588-5100",
            "fax_number": "631-588-5185"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "624 HAWKINS AVE",
            "address_2": "SUITE #1",
            "city": "LAKE RONKONKOMA",
            "state": "NY",
            "postal_code": "117792324",
            "telephone_number": "631-588-5100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCGOVERN",
        "first_name": "MICHAEL",
        "middle_name": "JAMES",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-07-13",
        "last_updated": "2008-05-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NY",
            "license": "TUV5891",
            "primary": true
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "TN",
            "license": "OD2344",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01870373",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kelly Teresa Marvullo
• Barbara Massaro, LMHC
• Robert Frederick Mazzeo, MD
• Fiona McBreen, LMSW
• Kerrin Maureen McBreen, CCC-SLP
• Meagan McGuigan, L.P.N.
• Jenna M McKenzie, FNP
• Nicole McLaughlin
• Medi Active Wheels LLC
• Medical Group Pharmacy Inc

• Optometrist in Lake Ronkonkoma, NY
• Providers in Lake Ronkonkoma, NY by specialty
• Optometrist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 13, 2008; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.