Active NPI
Michael James Sullivan, OD
- Optometrist
- Potsdam, NY
National Provider Identifier
1700168333
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- TUV007119-1
- Practice address
- 59 Elm St
Potsdam, NY 13676-1808 - Phone
- (315) 265-7417
- Fax
- (315) 265-7417
- NPI assigned
- Sep 9, 2011
- Last updated
- Sep 9, 2011
- 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 |
|---|---|---|---|---|
| Optometrist | 152W00000X | TUV007119-1 | NY | Primary |
Addresses
Primary practice location
59 Elm St
Potsdam, NY 13676-1808
Mailing address
125 Martin Ave. West
Winnipeg, MANITOBA R2L 0B3
CA
Phone (204) 663-8744
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 |
|---|---|---|---|
| TUV007119-1 | NY | MD | Optometrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Dr James B Sullivan | Optometrist | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Optometrist
- Potsdam, NY
- NPI 1619262029
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1315526400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1315526400000",
"number": "1700168333",
"addresses": [
{
"country_code": "CA",
"country_name": "Canada",
"address_purpose": "MAILING",
"address_type": "FGN",
"address_1": "125 MARTIN AVE. WEST",
"city": "WINNIPEG",
"state": "MANITOBA",
"postal_code": "R2L 0B3",
"telephone_number": "204-663-8744",
"fax_number": "204-663-6412"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "59 ELM ST",
"city": "POTSDAM",
"state": "NY",
"postal_code": "136761808",
"telephone_number": "315-265-7417",
"fax_number": "315-265-7417"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SULLIVAN",
"first_name": "MICHAEL",
"middle_name": "JAMES",
"name_prefix": "Dr.",
"credential": "OD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2011-09-09",
"last_updated": "2011-09-09",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "NY",
"license": "TUV007119-1",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Potsdam, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 9, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.