Ellvin John Mar, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

007221 Issued in NY

Practice address

834 Fort Salonga Rd Ste D
Northport, NY 11768-3157

Phone

(631) 757-4440

Fax

(631) 757-4593

NPI assigned

Nov 14, 2007

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 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, 2007

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Tan and Mar OptometryGroup PAC ID 1557689635, 2 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

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 and National Provider Directory roles.

• Tan & Mar Optometry

  • Optometrist
  • Northport, NY
  • NPI 1770973968
  Medicare reassignment Care Compare group NPD
• Luxottica of America Inc

  • Eyewear Supplier
  • Kansas City, MO
  • NPI 1497412522
  NPD (past)

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

{
    "created_epoch": "1194998400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1467676800000",
    "number": "1790965101",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "834 FORT SALONGA RD STE D",
            "city": "NORTHPORT",
            "state": "NY",
            "postal_code": "117683157",
            "telephone_number": "631-757-4440",
            "fax_number": "631-757-4593"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "834 FORT SALONGA RD STE D",
            "city": "NORTHPORT",
            "state": "NY",
            "postal_code": "117683157",
            "telephone_number": "631-757-4440",
            "fax_number": "631-757-4593"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAR",
        "first_name": "ELLVIN",
        "middle_name": "JOHN",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-11-14",
        "last_updated": "2016-07-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NY",
            "license": "007221",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• George Isaac Mallis, M.D.
• John J Malone, L.C.S.W., C.A.S.A.C.
• Leena Mangalath, LMSW
• Concetta Marie Manisero, NP
• Stephanie Mansfield
• Ellen C Marchese, LCSWR
• Marina Stauffer, Registered Dietitian, Certified Dietitian Nutritionis
• James Marinacci
• Christine Kathrine Marino, P.T.
• Rachel Sara Markfeld, M.S. CCC-SLP

• Optometrist in Northport, NY
• Providers in Northport, NY by specialty
• Optometrist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 5, 2016; 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.