Individual provider Active NPI

Victoria Leigh Dzurinko, O.D.

  • Optometrist
  • Deptford, NJ
National Provider Identifier
1679673958
Registry record updated Apr 16, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
OA000658900 Issued in NJ
Practice address
1710 Clements Bridge Rd
Deptford, NJ 08096-2010
Phone
(856) 537-7214
Fax
(856) 579-4354
NPI assigned
Sep 25, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 16, 2019

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

Specialties & licenses 6

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X OM00132800 NJ
Optometrist 152W00000X NH0786 NH
Optometrist 152W00000X 4666 MA
Optometrist 152W00000X OE000344G PA
Optometrist 152W00000X I3-0001407 DE
Optometrist 152W00000X OA000658900 NJ Primary

Addresses

Primary practice location

1710 Clements Bridge Rd
Deptford, NJ 08096-2010

Mailing address

PO Box 5401
Deptford, NJ 08096-0401
Phone (412) 994-0506

Other identifiers 1

IdentifierTypeStateIssuer
NH0786OtherNHEYEMED

Medicare participation

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

Enrollment IDStateProvider typePAC IDDetails
I20190513001517 NJ Practitioner - Optometry 3870516230 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Pennsylvania College of Optometry, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Eyecare Specialties Support of NJ PCGroup PAC ID 6800309287, 25 clinicians

Practice addresses (Care Compare)

901 Route 168
Suite 409 410
Blackwood, NJ 08012-3210
Phone (856) 408-1800

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
OA000658900NJMDOptometrist
OM00132800NJMDOptometrist
OE000344GPAMDOptometrist
4666MAMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Aeg Massachusetts Professional PC Optometrist PastSince Sep 26, 2024 Accepting new patients

Organizations & group practices 2

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": "1159142400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1555372800000",
    "number": "1679673958",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 5401",
            "city": "DEPTFORD",
            "state": "NJ",
            "postal_code": "080960401",
            "telephone_number": "412-994-0506"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1710 CLEMENTS BRIDGE RD",
            "city": "DEPTFORD",
            "state": "NJ",
            "postal_code": "080962010",
            "telephone_number": "856-537-7214",
            "fax_number": "856-579-4354"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DZURINKO",
        "first_name": "VICTORIA",
        "middle_name": "LEIGH",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-25",
        "last_updated": "2019-04-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NJ",
            "license": "OM00132800",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NH",
            "license": "NH0786",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MA",
            "license": "4666",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "PA",
            "license": "OE000344G",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "DE",
            "license": "I3-0001407",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NJ",
            "license": "OA000658900",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "EYEMED",
            "identifier": "NH0786",
            "state": "NH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Deptford, NJ

Sources for this page

Verify at the official NPI Registry.