Mark James Petrykowski, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

4222 Issued in OH

Practice address

1494 W Main St
Newark, OH 43055-1825

Phone

(740) 344-4747

NPI assigned

May 3, 2006

Last updated

Jun 9, 2011By 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 1

Medicare fee-for-service enrollment

Enrolled in OH

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

Ohio State University - College of Optometry, 1990

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

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.

• Del Opticians, LLC

  • Eyewear Supplier
  • Newark, OH
  • NPI 1851492763

  Optometrist

  Medicare reassignment NPD Authorized official
• Advanced Vision Care Doctors, LLC

  • Technician/Technologist
  • Zanesville, OH
  • NPI 1336348804
  NPD (past)

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

{
    "created_epoch": "1146614400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1307577600000",
    "number": "1811955347",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1494 W MAIN ST",
            "city": "NEWARK",
            "state": "OH",
            "postal_code": "430551825",
            "telephone_number": "740-344-4747"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1494 W MAIN ST",
            "city": "NEWARK",
            "state": "OH",
            "postal_code": "430551825",
            "telephone_number": "740-344-4747"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETRYKOWSKI",
        "first_name": "MARK",
        "middle_name": "JAMES",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-05-03",
        "last_updated": "2011-06-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "OH",
            "license": "4222",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0934958",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Emily Pessel
• Michele Peterman
• Avery Lorine Pethtel
• Jeffrey Petrey
• Thomas Petryk, MD
• Irina Sergeevna Petty, PA
• Brad T Pfau, MD
• Kyle Edwin Pfeifer, MS, APRN, NP-C
• James Edward Pfister, MSW, LISW
• William H Phillips, D.O.

• Optometrist in Newark, OH
• Providers in Newark, OH by specialty
• Optometrist in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 9, 2011; 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.