Active NPI
Justin Robert Edwards, OPTICIAN
- Optician
- Camillus, NY
National Provider Identifier
1730657388
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optician
- License
- C009325
- Practice address
- 5399 W Genesee St
Camillus, NY 13031-2265 - Phone
- (315) 468-2745
- Fax
- (315) 468-2786
- NPI assigned
- Nov 12, 2018
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Optician | 156FX1800X | C009325 | NY | Primary |
Addresses
Primary practice location
5399 W Genesee St
Camillus, NY 13031-2265
Mailing address
5399 W Genesee St
Camillus, NY 13031-2265
Phone (315) 468-2745
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 |
|---|---|---|---|
| C009325 | NY | MD | Optician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1541980800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1541980800000",
"number": "1730657388",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5399 W GENESEE ST",
"city": "CAMILLUS",
"state": "NY",
"postal_code": "130312265",
"telephone_number": "315-468-2745",
"fax_number": "315-468-2786"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5399 W GENESEE ST",
"city": "CAMILLUS",
"state": "NY",
"postal_code": "130312265",
"telephone_number": "315-468-2745",
"fax_number": "315-468-2786"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EDWARDS",
"first_name": "JUSTIN",
"middle_name": "ROBERT",
"credential": "OPTICIAN",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2018-11-12",
"last_updated": "2018-11-12",
"status": "A"
},
"taxonomies": [
{
"code": "156FX1800X",
"taxonomy_group": "",
"desc": "Technician/Technologist, Optician",
"state": "NY",
"license": "C009325",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Camillus, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 12, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.