South Park Optical, Inc.

Primary specialty

Eyewear SupplierTaxonomy code 332H00000X

License

5093 Issued in NY

Legal business name

SOUTH PARK OPTICAL, INC.

Practice address

3861 S Park Ave
Blasdell, NY 14219-1813

Phone

(716) 823-6093

NPI assigned

Oct 11, 2006

Last updated

Dec 5, 2014By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

James Gordon Beiter Sr.NPI 1275974230

Title

Optician

Phone

(716) 823-6093

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

Locations

Practitioners 4

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.

• James Gordon Beiter Jr., O.D.

  • Optometrist
  • Blasdell, NY
  • NPI 1275974230
  Medicare reassignment Authorized official
• John Bielinski, O.D.

  • Optometrist
  • Blasdell, NY
  • NPI 1366537532
  NPD (past)
• Robert H Hornberger Jr., OD

  • Optometrist
  • Buffalo, NY
  • NPI 1033109293
  NPD (past)
• Timothy Micah Johnson, O.D.

  • Optometrist
  • Amherst, NY
  • NPI 1790019008
  NPD (past)

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

{
    "created_epoch": "1160524800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1417737600000",
    "number": "1700974946",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3861 S PARK AVE",
            "city": "BLASDELL",
            "state": "NY",
            "postal_code": "142191813"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3861 S PARK AVE",
            "city": "BLASDELL",
            "state": "NY",
            "postal_code": "142191813",
            "telephone_number": "716-823-6093"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH PARK OPTICAL, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-11",
        "last_updated": "2014-12-05",
        "status": "A",
        "authorized_official_last_name": "BEITER",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "GORDON",
        "authorized_official_title_or_position": "OPTICIAN",
        "authorized_official_telephone_number": "716-823-6093",
        "authorized_official_name_suffix": "Sr."
    },
    "taxonomies": [
        {
            "code": "332H00000X",
            "taxonomy_group": "",
            "desc": "Eyewear Supplier",
            "state": "NY",
            "license": "5093",
            "primary": true
        },
        {
            "code": "156FX1800X",
            "taxonomy_group": "",
            "desc": "Technician/Technologist, Optician",
            "state": "NY",
            "license": "C-5093-1",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Heidi Rusinek
• Tony Sakr, PHARMD
• Sarah Sciarrino, D.D.S.
• Shalini Sharma, O.D.
• Kayla Smith, RDH
• Tammy M Stafford, L.M.T.
• Peter F. Starkey, DDS
• Melissa Marie Stewart, PHARMD
• Randi Gail Stewart, OD
• Ryan Joel Sullivan, D.M.D.

• Eyewear Supplier in Blasdell, NY
• Providers in Blasdell, NY by specialty
• Eyewear Supplier in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 5, 2014; 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.