NPIMap

Organization Active NPI

Crystal Eyewear Inc

  • Optician
  • Elmhurst, NY
National Provider Identifier
1770068645
Registry record updated Sep 26, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
OpticianTaxonomy code 156FX1800X
Legal business name
CRYSTAL EYEWEAR INC
Practice address
9015 Queens Blvd Ste 1029
Elmhurst, NY 11373-4914
Phone
(718) 760-2020
NPI assigned
Sep 26, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 26, 2018

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

Authorized official

Name
Boris Bangiyev
Title
Supervisor
Phone
(646) 321-5802

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OpticianGroup: 193400000X SINGLE SPECIALTY GROUP 156FX1800X Primary

Addresses

Primary practice location

9015 Queens Blvd Ste 1029
Elmhurst, NY 11373-4914

Mailing address

9015 Queens Blvd Ste 1029
Elmhurst, NY 11373-4914

Other names 1

  • Fabulous Optical Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20190207001143 NY Part B Supplier - Clinic/Group Practice 5799023271 Receives reassigned benefits from 12 practitioners
Practice locations: Elmhurst, NY

National Provider Directory

National Provider Directory

Locations

9015 Queens Blvd
Ste 1029
Elmhurst, NY 11373
Phone (718) 760-2020

Practitioners & affiliated clinicians

Practitioners 12

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": "1537920000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1537920000000",
    "number": "1770068645",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9015 QUEENS BLVD STE 1029",
            "city": "ELMHURST",
            "state": "NY",
            "postal_code": "113734914"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9015 QUEENS BLVD STE 1029",
            "city": "ELMHURST",
            "state": "NY",
            "postal_code": "113734914",
            "telephone_number": "718-760-2020"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CRYSTAL EYEWEAR INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-09-26",
        "last_updated": "2018-09-26",
        "status": "A",
        "authorized_official_last_name": "BANGIYEV",
        "authorized_official_first_name": "BORIS",
        "authorized_official_title_or_position": "SUPERVISOR",
        "authorized_official_telephone_number": "646-321-5802"
    },
    "taxonomies": [
        {
            "code": "156FX1800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Technician/Technologist, Optician",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Fabulous Optical",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Elmhurst, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 26, 2018; 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.