Pelham Parkway Vision Center Inc

Primary specialty

Vision Therapy OptometristTaxonomy code 152WV0400X

License

006388 Issued in NY

Legal business name

PELHAM PARKWAY VISION CENTER INC

Practice address

731 Lydig Ave
Bronx, NY 10462-2103

Phone

(718) 829-2160

Fax

(718) 829-9502

NPI assigned

May 3, 2007

Last updated

Apr 14, 2021By 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

Oleg Lisitsyn, ODNPI 1811948052

Title

Part Owner

Phone

(718) 829-2160

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

Locations

Practitioners 7

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.

• Oleg Lisitsyn, OD

  • Optometrist
  • Bronx, NY
  • NPI 1811948052
  Medicare reassignment Care Compare group NPD Authorized official
• Diana Ilyasova, O.D.

  • Optometrist
  • Bronx, NY
  • NPI 1629302658
  Medicare reassignment Care Compare group NPD
• Inna Ilyasova

  • Optometrist
  • Bronx, NY
  • NPI 1225708944
  Medicare reassignment Care Compare group NPD
• Jina Yoo, OD

  • Optometrist
  • Bronx, NY
  • NPI 1104652668
  Medicare reassignment Care Compare group NPD
• Inji Kang, OD

  • Optometrist
  • Bronx, NY
  • NPI 1235046749
  NPD (past)
• Michael Orloff

  • Optician
  • Bronx, NY
  • NPI 1336392885
  NPD (past)
• Eleonora Tamayeva, OD

  • Optometrist
  • Great Neck, NY
  • NPI 1063768109
  NPD (past)

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

{
    "created_epoch": "1178150400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1618358400000",
    "number": "1740402205",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "735 LYDIG AVE",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104622103",
            "telephone_number": "718-829-2160",
            "fax_number": "718-829-9502"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "731 LYDIG AVE",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104622103",
            "telephone_number": "718-829-2160",
            "fax_number": "718-829-9502"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PELHAM PARKWAY VISION CENTER INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-03",
        "last_updated": "2021-04-14",
        "certification_date": "2021-04-14",
        "status": "A",
        "authorized_official_last_name": "LISITSYN",
        "authorized_official_first_name": "OLEG",
        "authorized_official_title_or_position": "PART OWNER",
        "authorized_official_telephone_number": "718-829-2160",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152WV0400X",
            "taxonomy_group": "",
            "desc": "Optometrist, Vision Therapy",
            "state": "NY",
            "license": "006388",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Vision Therapy Optometrist in Bronx, NY
• Providers in Bronx, NY by specialty
• Vision Therapy Optometrist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 14, 2021; 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.