Active NPI
Marie Diane Forman, LDO
- Optician
- Geneseo, NY
National Provider Identifier
1740035294
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optician
- License
- 01035-01
- Practice address
- 4235 Veteran Dr
Geneseo, NY 14454-9442 - Phone
- (585) 243-4004
- Fax
- (585) 243-4009
- NPI assigned
- Apr 18, 2024
- Sex
- Female
- Sole proprietor
- Yes
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 | 01035-01 | NY | Primary |
Addresses
Primary practice location
4235 Veteran Dr
Geneseo, NY 14454-9442
Mailing address
4235 Veteran Dr
Geneseo, NY 14454-9442
Phone (585) 243-4004
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 |
|---|---|---|---|
| 01035-01 | NY | MD | Optician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1713398400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1713398400000",
"number": "1740035294",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4235 VETERAN DR",
"city": "GENESEO",
"state": "NY",
"postal_code": "144549442",
"telephone_number": "585-243-4004",
"fax_number": "585-243-4009"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4235 VETERAN DR",
"city": "GENESEO",
"state": "NY",
"postal_code": "144549442",
"telephone_number": "585-243-4004",
"fax_number": "585-243-4009"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FORMAN",
"first_name": "MARIE",
"middle_name": "DIANE",
"name_prefix": "Ms.",
"credential": "LDO",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2024-04-18",
"last_updated": "2024-04-18",
"certification_date": "2024-04-18",
"status": "A"
},
"taxonomies": [
{
"code": "156FX1800X",
"taxonomy_group": "",
"desc": "Technician/Technologist, Optician",
"state": "NY",
"license": "01035-01",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Geneseo, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 18, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.