Active NPI
Justin Pecori, O.D.
- Optometrist
- Evans Mills, NY
National Provider Identifier
1780947119
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- TUV007828
- Practice address
- 25737 US Route 11
Evans Mills, NY 13637-3221 - Phone
- (315) 629-4316
- NPI assigned
- Jun 20, 2012
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | TUV007828 | NY | Primary |
Addresses
Primary practice location
25737 US Route 11
Evans Mills, NY 13637-3221
Mailing address
22282 Swan Rd
Watertown, NY 13601-5782
Medicare participation
Medicare enrollment files- 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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20130212000438 | NY | Practitioner - Optometry | 8123272507 | Practice locations: Evans Mills, NY |
Care Compare profile
Medicare Care Compare- Specialty
- Optometry
- Education
- New England College of Optometry, 2008
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
25737 US Route 11
Evans Mills, NY 13637-3221
Phone (315) 629-4316
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| TUV007828 | NY | MD | Optometrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1340150400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1340150400000",
"number": "1780947119",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "22282 SWAN RD",
"city": "WATERTOWN",
"state": "NY",
"postal_code": "136015782"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "25737 US ROUTE 11",
"city": "EVANS MILLS",
"state": "NY",
"postal_code": "136373221",
"telephone_number": "315-629-4316"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PECORI",
"first_name": "JUSTIN",
"credential": "O.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2012-06-20",
"last_updated": "2012-06-20",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "NY",
"license": "TUV007828",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Evans Mills, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 2012; 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.