O.D. Optometric P.C.

Primary specialty

OptometristTaxonomy code 152W00000X

License

TUV006278 Issued in NY

Legal business name

O.D. OPTOMETRIC P.C.

Practice address

4255 McKinley Pkwy
Hamburg, NY 14075-1005

Phone

(716) 646-0564

Fax

(716) 646-0571

NPI assigned

Oct 18, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Charles Michael San George II, O.D.NPI 1750387353

Title

President

Phone

(716) 646-0564

Specialties & licenses 1

Addresses

Other identifiers 9

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Charles M Sangeorge II, O.D.

  • Optometrist
  • Hamburg, NY
  • NPI 1750387353
  Medicare reassignment NPD Authorized official
• Charles San George

  • Optician
  • Buffalo, NY
  • NPI 1932697646
  NPD (past)
• Heather May Sodaro, PHARM. D.

  • Pharmacist
  • Lockport, NY
  • NPI 1093037590
  NPD (past)
• Pamela S Welch, RPH

  • Pharmacist
  • Lockport, NY
  • NPI 1760655963
  NPD (past)

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

{
    "created_epoch": "1161129600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1529539200000",
    "number": "1831270701",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4255 MCKINLEY PKWY",
            "address_2": "INSIDE WAL-MART VISION CENTER",
            "city": "HAMBURG",
            "state": "NY",
            "postal_code": "140751005",
            "telephone_number": "716-646-0564"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4255 MCKINLEY PKWY",
            "city": "HAMBURG",
            "state": "NY",
            "postal_code": "140751005",
            "telephone_number": "716-646-0564",
            "fax_number": "716-646-0571"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "O.D. OPTOMETRIC P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-18",
        "last_updated": "2018-06-21",
        "status": "A",
        "authorized_official_last_name": "SAN GEORGE",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_middle_name": "MICHAEL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "716-646-0564",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "II",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "NY",
            "license": "TUV006278",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUECROSS BLUESHIELD",
            "identifier": "000390184006",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NVA",
            "identifier": "552405",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AVESIS",
            "identifier": "13693",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DAVIS VISION",
            "identifier": "48568",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "COLE MANAGED VISION",
            "identifier": "NY6278",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNIVERA",
            "identifier": "00027038101",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SPECTERA",
            "identifier": "17205",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLOCK VISION",
            "identifier": "919920",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLARITY VISION",
            "identifier": "988665",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Alix Marie Novack
• James C Nowak, LMT
• Kathleen Mary Nowak, D.D.S.
• Christopher Todd Nutty, NP
• Jessica Erin Nyrop, D.C.
• Jessica Leigh O'Donnell, OTR/L
• Brianna O'Neill
• Carrie Occhino
• Frederick M Occhino, D.O.
• Linda Oconnor

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 21, 2018; 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.