Supreme Eyecare Center Corp

Primary specialty

OptometristTaxonomy code 152W00000X

Legal business name

SUPREME EYECARE CENTER CORP

Doing business as

Supreme Optical

Practice address

457 Knickerbocker Ave
Brooklyn, NY 11237-5107

Phone

(646) 321-5802

NPI assigned

Aug 19, 2022

Organization subpart

No

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

Authorized official

Name

Boris Bangiyev

Title

Owner

Phone

(646) 321-5802

Specialties & licenses 1

Addresses

Other names 1

• Supreme Optical Doing business as

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

Locations

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Gauhar Kanimetova, OD

  • Optometrist
  • Brooklyn, NY
  • NPI 1033604517
  Medicare reassignment NPD
• Marina Presman, DOCTOR OF OPTOMETRY

  • Optometrist
  • Jamaica, NY
  • NPI 1699243600
  Medicare reassignment NPD
• Gursewak Singh, OD

  • Optometrist
  • Brooklyn, NY
  • NPI 1891476347
  Medicare reassignment NPD
• Leonard Colluro, RPH

  • Pharmacist
  • Brooklyn, NY
  • NPI 1528399631
  NPD (past)
• Gary Goffner, RPH

  • Pharmacist
  • Brooklyn, NY
  • NPI 1306177407
  NPD (past)

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

{
    "created_epoch": "1660867200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1660867200000",
    "number": "1699493049",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "457 KNICKERBOCKER AVE",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112375107",
            "telephone_number": "646-321-5802"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "457 KNICKERBOCKER AVE",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112375107",
            "telephone_number": "646-321-5802"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUPREME EYECARE CENTER CORP",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-08-19",
        "last_updated": "2022-08-19",
        "certification_date": "2022-08-19",
        "status": "A",
        "authorized_official_last_name": "BANGIYEV",
        "authorized_official_first_name": "BORIS",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "646-321-5802"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Supreme Optical",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Supportive Home Care LLC
• Supportive Home Care LLC (Care365 HomeCare)
• Supreme Care Physical Therapy and Occupational Therapy, PLLC (Evolve Physical Therapy and Sports Rehabilitation)
• Supreme Diagnostics LLC
• Supreme DME Ny
• Supreme Optical Inc
• Supreme Patient Advocates
• Supreme RX Pharmacy Corp
• Supreme RX Pharmacy Corp
• Suprx Pharmacy Inc

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.