Optical Lab

Primary specialty

OptometristTaxonomy code 152W00000X

Legal business name

OPTICAL LAB

Practice address

4620 16TH Ave
Brooklyn, NY 11204-1104

Phone

(718) 954-4330

Fax

(718) 871-6322

NPI assigned

Feb 13, 2019

Organization subpart

No

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

Authorized official

Name

Mr. Shalom Holtzbergh

Title

Owner

Phone

(718) 954-4330

Specialties & licenses 1

Addresses

Locations

Practitioners 2

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.

• Shalom Holtzberg, OPTICIAN

  • Optician
  • Brooklyn, NY
  • NPI 1861878159
  NPD (past)
• Itzhak Medan, M.D.

  • General Practice Physician
  • Richboro, PA
  • NPI 1346485745
  NPD (past)

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

{
    "created_epoch": "1550016000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1550016000000",
    "number": "1700342987",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4620 16TH AVE",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112041104",
            "telephone_number": "718-954-4330",
            "fax_number": "718-871-6322"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4620 16TH AVE",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112041104",
            "telephone_number": "718-954-4330",
            "fax_number": "718-871-6322"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OPTICAL LAB",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-02-13",
        "last_updated": "2019-02-13",
        "status": "A",
        "authorized_official_last_name": "HOLTZBERGH",
        "authorized_official_first_name": "SHALOM",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "718-954-4330",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• 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 Feb 13, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.