Individual provider Active NPI

Jack Safier

  • Optometrist
  • Youngstown, OH
National Provider Identifier
1700854403
Registry record updated Apr 9, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
3201 T633 Issued in OH
Practice address
3711 Sampson Rd
Youngstown, OH 44505-1629
Phone
(330) 718-2097
NPI assigned
Mar 9, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 9, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 3201 T633 OH Primary

Addresses

Primary practice location

3711 Sampson Rd
Youngstown, OH 44505-1629

Mailing address

3711 Sampson Rd
Youngstown, OH 44505-1629
Phone (330) 718-2097

Other identifiers 1

IdentifierTypeStateIssuer
0352103MedicaidOH

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
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
I20100824000640 OH Practitioner - Optometry 0345364691 Practice locations: Youngstown, OH

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
3201 T633OHMDOptometrist

NPI Registry JSON

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

{
    "created_epoch": "1141862400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1649462400000",
    "number": "1700854403",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3711 SAMPSON RD",
            "city": "YOUNGSTOWN",
            "state": "OH",
            "postal_code": "445051629",
            "telephone_number": "330-718-2097"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3711 SAMPSON RD",
            "city": "YOUNGSTOWN",
            "state": "OH",
            "postal_code": "445051629",
            "telephone_number": "330-718-2097"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SAFIER",
        "first_name": "JACK",
        "name_prefix": "Dr.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-03-09",
        "last_updated": "2022-04-09",
        "certification_date": "2022-04-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "OH",
            "license": "3201   T633",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0352103",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Youngstown, OH

Sources for this page

Verify at the official NPI Registry.