Roman S Kakzanov, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

TUV008183-1 Issued in NY

Practice address

119-15 Atlantic Avenue
Richmond Hill, NY 11418

Phone

(718) 805-0700

Fax

(718) 805-5621

NPI assigned

Jun 23, 2014

Last updated

Sep 20, 2018By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NY

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Optometry

Education

State University of New York - State College Optometry, 2014

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Ahava Medical and Rehabilitation Center, LLCGroup PAC ID 1557416997, 150 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Ahava Medical and Rehabilitation Center, LLC

  • Rehabilitation Practitioner
  • Brooklyn, NY
  • NPI 1184878274
  Medicare reassignment Care Compare group NPD
• Perry Ave Family Medical Center Inc

  • Family Medicine Physician
  • Bronx, NY
  • NPI 1619973518
  Medicare reassignment NPD
• Pro Optics Corp

  • Optometrist
  • Bronx, NY
  • NPI 1013171149
  Medicare reassignment NPD
• Rego Park Counseling LLC

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Rego Park, NY
  • NPI 1235760927
  Medicare reassignment NPD
• Swift Optometry Care PC

  • Optometrist
  • Tolland, CT
  • NPI 1063753887

  NY

  Medicare reassignment NPD
• Pure Eyecare Optometry P.C.

  dba Pure Eyecare

  • Medical Specialty Clinic/Center
  • Forest Hills, NY
  • NPI 1285278606
  Authorized official Same address or phone
• Rego Park Counseling LLC

  • Clinical Medical Laboratory
  • Rego Park, NY
  • NPI 1528759073
  NPD
• Rego Park Counseling LLC

  • Multi-Specialty Clinic/Center
  • Fresh Meadows, NY
  • NPI 1932061611
  NPD

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

{
    "created_epoch": "1403481600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1537401600000",
    "number": "1760897383",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "105-24 64RD FOREST HILLS APT 2S",
            "city": "NY",
            "state": "NY",
            "postal_code": "11375",
            "telephone_number": "917-476-7757"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "119-15 ATLANTIC AVENUE",
            "city": "RICHMOND HILL",
            "state": "NY",
            "postal_code": "11418",
            "telephone_number": "718-805-0700",
            "fax_number": "718-805-5621"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KAKZANOV",
        "first_name": "ROMAN",
        "middle_name": "S",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-06-23",
        "last_updated": "2018-09-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NY",
            "license": "TUV008183-1",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03966603",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Seong Eun Ju
• Jupiter DME LLC
• Joanna Kabat-Rey, LMHC LCAT CASAC
• Yelena Kafarskaya
• Muhammad Imran Kafeel, M.D.
• Karin Kalkstein, MD
• Sumithra Nanjappa Kambi, MD
• Ali Kanan, MD
• Narayan Kandel, MD
• Kanter Physical Medicine & Rehab PC

• Optometrist in Richmond Hill, NY
• Providers in Richmond Hill, NY by specialty
• Optometrist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 20, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.