NPIMap

Organization Active NPI

Optometric Physicians of Middletown PA

  • Optometrist
  • Brick, NJ
National Provider Identifier
1811575962
Registry record updated Mar 31, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
Legal business name
OPTOMETRIC PHYSICIANS OF MIDDLETOWN PA
Practice address
359 Brick Blvd
Brick, NJ 08723-6010
Phone
(732) 920-1330
Fax
(732) 920-1330
NPI assigned
Mar 31, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 31, 2021

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

Authorized official

Name
James Wachter
Title
Cmo
Phone
(636) 200-4393

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X Primary

Addresses

Primary practice location

359 Brick Blvd
Brick, NJ 08723-6010

Mailing address

786 Highway 35
Middletown, NJ 07748-3410
Phone (732) 671-7300

Other names 1

  • Clarkson Eyecare Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20071008000370 NJ Part B Supplier - Clinic/Group Practice 8527153410 Receives reassigned benefits from 22 practitioners
9 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Eatontown, NJ; Sea Girt, NJ; Red Bank, NJ; Middletown, NJ; Matawan, NJ; Manchester, NJ; Howell, NJ; Hazlet, NJ…

Other NPIs on the same Medicare enrollment 9

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Clarkson Eyecare8 organizations share this tax ID, including this one

Other organizations with this tax ID 7

Organizations that report the same tax identification number in the National Provider Directory.

Locations

359 Brick Blvd
Brick, NJ 08723
Phone (732) 920-1330

Practitioners & affiliated clinicians

Practitioners 1

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": "1617148800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1617148800000",
    "number": "1811575962",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "786 HIGHWAY 35",
            "city": "MIDDLETOWN",
            "state": "NJ",
            "postal_code": "077483410",
            "telephone_number": "732-671-7300",
            "fax_number": "732-706-1605"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "359 BRICK BLVD",
            "city": "BRICK",
            "state": "NJ",
            "postal_code": "087236010",
            "telephone_number": "732-920-1330",
            "fax_number": "732-920-1330"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OPTOMETRIC PHYSICIANS OF MIDDLETOWN PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-03-31",
        "last_updated": "2021-03-31",
        "certification_date": "2021-03-31",
        "status": "A",
        "authorized_official_last_name": "WACHTER",
        "authorized_official_first_name": "JAMES",
        "authorized_official_title_or_position": "CMO",
        "authorized_official_telephone_number": "636-200-4393"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Clarkson Eyecare",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Brick, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 31, 2021; 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.