Organization Active NPI

Tina Ansari OD & Associates, LLC

  • Optometrist
  • Gainesville, VA
National Provider Identifier
1760060743
Registry record updated Jun 1, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
Legal business name
TINA ANSARI OD & ASSOCIATES, LLC
Practice address
13934 Estate Manor Dr Unit J
Gainesville, VA 20155-5951
Phone
(804) 605-9821
NPI assigned
Mar 31, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 1, 2021

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

Authorized official

Name
Dr. Tina Ansari, ODNPI 1487062519
Title
Owner
Phone
(703) 594-9099

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X Primary

Addresses

Primary practice location

13934 Estate Manor Dr Unit J
Gainesville, VA 20155-5951

Mailing address

13934 Estate Manor Dr Unit J
Gainesville, VA 20155-5951
Phone (703) 594-9099

Other names 1

  • Lumen Eye Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20211124002205 VA Part B Supplier - Clinic/Group Practice 9133519614 Receives reassigned benefits from 2 practitioners
Practice locations: Gainesville, VA

National Provider Directory

National Provider Directory

Locations

13934 Estate Manor Dr
Unit J
Gainesville, VA 20155
Phone (703) 594-9099

13934 Estate Manor Dr
Gainesville, VA 20155

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1617148800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1622505600000",
    "number": "1760060743",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13934 ESTATE MANOR DR UNIT J",
            "city": "GAINESVILLE",
            "state": "VA",
            "postal_code": "201555951",
            "telephone_number": "703-594-9099"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13934 ESTATE MANOR DR UNIT J",
            "city": "GAINESVILLE",
            "state": "VA",
            "postal_code": "201555951",
            "telephone_number": "804-605-9821"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TINA ANSARI OD & ASSOCIATES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-03-31",
        "last_updated": "2021-06-01",
        "certification_date": "2021-06-01",
        "status": "A",
        "authorized_official_last_name": "ANSARI",
        "authorized_official_first_name": "TINA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "703-594-9099",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lumen Eye Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Gainesville, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 1, 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.