Paul Mastrorocco, DISPENSING OPTICIAN

Primary specialty

OpticianTaxonomy code 156FX1800X

License

5855-1 Issued in NY

Practice address

208 Route 112 Ste 2
Port Jefferson Station, NY 11776-1013

Phone

(631) 331-0600

Fax

(631) 331-0809

NPI assigned

Nov 18, 2008

Last updated

Sep 17, 2021By the provider in NPPES

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

Other identifiers 4

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not 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.

• Brookhaven Opticians Inc.

  • Eyewear Supplier
  • Smithtown, NY
  • NPI 1821115155
  NPD Authorized official
• East Main Street Opticians Inc.

  dba Brookhaven Opticians

  • Eyewear Supplier
  • Patchogue, NY
  • NPI 1982721288
  NPD Authorized official
• Port Jefferson Opticians Inc

  dba Brookhaven Opticians

  • Durable Medical Equipment & Medical Supplies
  • Port Jefferson Station, NY
  • NPI 1154443158

  Optician

  NPD Authorized official
• Stony Brook Opticians Inc

  dba Wiggs Opricians

  • Eyewear Supplier
  • Stony Brook, NY
  • NPI 1588994651

  Optician

  NPD (past) Authorized official
• Rory Bowman OD PC

  • Optometrist
  • Stony Brook, NY
  • NPI 1124347729
  NPD (past)

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

{
    "created_epoch": "1226966400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1631836800000",
    "number": "1801041843",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "180 E MAIN ST",
            "address_2": "SUITE 104",
            "city": "PATCHOGUE",
            "state": "NY",
            "postal_code": "117723171",
            "telephone_number": "631-475-5030",
            "fax_number": "631-475-5037"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "208 ROUTE 112 STE 2",
            "city": "PORT JEFFERSON STATION",
            "state": "NY",
            "postal_code": "117761013",
            "telephone_number": "631-331-0600",
            "fax_number": "631-331-0809"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "180 E Main St Ste 104",
            "address_purpose": "LOCATION",
            "city": "Patchogue",
            "state": "NY",
            "postal_code": "117723116",
            "country_code": "US",
            "telephone_number": "631-475-5030",
            "fax_number": "631-475-5037",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "125 Main St",
            "address_purpose": "LOCATION",
            "city": "Stony Brook",
            "state": "NY",
            "postal_code": "117901911",
            "country_code": "US",
            "telephone_number": "631-751-2801",
            "fax_number": "631-751-2832",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "79 E Main St Ste D",
            "address_purpose": "LOCATION",
            "city": "Smithtown",
            "state": "NY",
            "postal_code": "117872867",
            "country_code": "US",
            "telephone_number": "631-265-5767",
            "fax_number": "631-265-9624",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MASTROROCCO",
        "first_name": "PAUL",
        "name_prefix": "Mr.",
        "credential": "DISPENSING OPTICIAN",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-11-18",
        "last_updated": "2021-09-17",
        "certification_date": "2021-09-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "156FX1800X",
            "taxonomy_group": "",
            "desc": "Technician/Technologist, Optician",
            "state": "NY",
            "license": "5855-1",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00342952",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00683849",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01934578",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03292940",
            "state": "NY"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "patchogue@brookhavenopticians.com",
            "affiliation": "N",
            "endpointDescription": "Management email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "Management email",
            "address_1": "180 E Main St Ste 104",
            "city": "Patchogue",
            "state": "NY",
            "country_code": "US",
            "postal_code": "117723116",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Jade Maslosky, REGISTERED NURSE
• Felicity Joy Masone
• Gabrielle Luisa Massucci, MS CF-SLP TSSLD
• Kristyn Leigh Mastridge
• Andrew Vincent Mastronardi, DMD
• Kenneth Ryan Mataragas, PA-C
• Mather Faculty Medical Affiliates, University Faculty Practice Corp
• Karen Matragrano, NP-C
• Kelly A. Matthews, LPN
• Michele Marie Mayer, N.P., C.N.M.

• Optician in Port Jefferson Station, NY
• Providers in Port Jefferson Station, NY by specialty
• Optician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 17, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.