Taras Walter Spivak, O.D.

Primary specialty

Corneal and Contact Management OptometristTaxonomy code 152WC0802X

License

27OA00290500 Issued in NJ

Practice address

128 N Delsea Dr
Clayton, NJ 08312-1602

Phone

(856) 881-4089

Fax

(856) 881-4013

NPI assigned

Jun 23, 2005

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NJ

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

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1119484800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1292716800000",
    "number": "1770589889",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "128 N DELSEA DR",
            "city": "CLAYTON",
            "state": "NJ",
            "postal_code": "083121602",
            "telephone_number": "856-881-4089",
            "fax_number": "856-881-4013"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "128 N DELSEA DR",
            "city": "CLAYTON",
            "state": "NJ",
            "postal_code": "083121602",
            "telephone_number": "856-881-4089",
            "fax_number": "856-881-4013"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SPIVAK",
        "first_name": "TARAS",
        "middle_name": "WALTER",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-06-23",
        "last_updated": "2010-12-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152WC0802X",
            "taxonomy_group": "",
            "desc": "Optometrist, Corneal and Contact Management",
            "state": "NJ",
            "license": "27OA00290500",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Marconi Chu-Chu Sackor
• Alisha Sheppard
• Kayisha Shoultz
• Renee Smallhorne
• Soraya Health Care
• Carole T Thompson, ED.S, MA, LPC
• TLC Pregnancy and Beyond
• Dora Villamarin
• Jennifer Nicole Warriner, PHARMD
• Pamela K Whitehead

• Corneal and Contact Management Optometrist in Clayton, NJ
• Providers in Clayton, NJ by specialty
• Corneal and Contact Management Optometrist in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 19, 2010; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.