Evergreen Optometry PLLC

Primary specialty

OptometristTaxonomy code 152W00000X

Legal business name

EVERGREEN OPTOMETRY PLLC

Doing business as

Evergreen Eye Care

Practice address

17 Long Ave Ste 102
Hamburg, NY 14075-6200

Phone

(716) 831-2717

Fax

(716) 831-2718

NPI assigned

Apr 12, 2024

Last updated

May 30, 2024By 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

Dr. Mackenzie Anne Bradley, ODNPI 1124640305

Title

Optometrist

Phone

(716) 831-2717

Specialties & licenses 1

Addresses

Other names 1

• Evergreen Eye Care Doing business as

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

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.

• Mackenzie Anne Bradley, OD

  • Optometrist
  • New York, NY
  • NPI 1124640305
  Medicare reassignment Care Compare group NPD Authorized official
• David Spengler, OD

  • Optometrist
  • Southport, CT
  • NPI 1225624448

  NY

  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1712880000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1717027200000",
    "number": "1710731104",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4845 TRANSIT RD APT B7",
            "city": "DEPEW",
            "state": "NY",
            "postal_code": "140434717",
            "telephone_number": "716-831-2717"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17 LONG AVE STE 102",
            "city": "HAMBURG",
            "state": "NY",
            "postal_code": "140756200",
            "telephone_number": "716-831-2717",
            "fax_number": "716-831-2718"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVERGREEN OPTOMETRY PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-04-12",
        "last_updated": "2024-05-30",
        "certification_date": "2024-05-30",
        "status": "A",
        "authorized_official_last_name": "BRADLEY",
        "authorized_official_first_name": "MACKENZIE",
        "authorized_official_middle_name": "ANNE",
        "authorized_official_title_or_position": "OPTOMETRIST",
        "authorized_official_telephone_number": "716-831-2717",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Evergreen Eye Care",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Evergreen Eye Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Nicole M Enzinna, D.C., LMT
• Joseph Anthony Eppolito, RPH
• Jane Epstein, LCSW-R
• Eric H. Goodwin MD PC
• Robert M Erickson
• Eric Fattey, PT DPT
• Donna Fazekas, LCSW-R
• Rebecca Fazio, LMSW
• John Patrick Feldmann, MS CCC-SLP
• Deborah Gants Felschow, LCSW

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 30, 2024; 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.