A Dussan Services LLC – Optometrist

Key facts

NPI: 1831759810
Entity type: Organization (NPI type 2)
Primary specialty: Optometrist 152W00000X
Legal business name: A DUSSAN SERVICES LLC
Practice address: 1016 50TH Ave
Long Island City, NY 11101-6273
Phone: (516) 792-6901
NPI assigned: Jun 20, 2019
Organization subpart: No

Authorized official

Name: Angela Dussan, OD NPI 1205115474
Title: Optometrist
Phone: (347) 242-3884

Authorized official NPPES reports the authorized official by name only; the link goes to the one practitioner connected to this organization with that name.

Practitioners 1

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

Angela V Dussan, OD Corneal and Contact Management Optometrist · Long Island City, NY · NPI 1205115474

Medicare reassignment Authorized official NY

Medicare participation

Medicare fee-for-service enrollment: Enrolled in NY

Medicare enrollment records

Enrollment ID	State	Provider type	PAC ID	Details
O20190812000469	NY	Part B Supplier - Clinic/Group Practice	5395072599	Receives reassigned benefits from 1 practitioner Practice locations: Long Island City, NY

National Provider Directory

Locations

9741 Queens Blvd
Rego Park, NY 11374
Phone (347) 242-3884

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Optometrist Group: 193400000X SINGLE SPECIALTY GROUP	152W00000X			Yes

Addresses

Primary practice location

1016 50TH Ave
Long Island City, NY 11101-6273

Mailing address

1016 50TH Ave
Long Island City, NY 11101-6273
Phone (516) 792-6901

Other identifiers

Identifier	Type	State	Issuer
03487065	Medicaid	NY

Other names

A DUSSAN SERVICES LLC Doing business as
Dussan eye care Doing business as

Electronic endpoints

Type	Endpoint	Use	Affiliation
CONNECT URL	https://www.zocdoc.com/doctor/angela-dussan-od-161773	Direct

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Aug 28, 2019.

{
    "created_epoch": "1560988800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1566950400000",
    "number": "1831759810",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1016 50TH AVE",
            "city": "LONG ISLAND CITY",
            "state": "NY",
            "postal_code": "111016273",
            "telephone_number": "516-792-6901"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1016 50TH AVE",
            "city": "LONG ISLAND CITY",
            "state": "NY",
            "postal_code": "111016273",
            "telephone_number": "516-792-6901"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "A DUSSAN SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-06-20",
        "last_updated": "2019-08-28",
        "status": "A",
        "authorized_official_last_name": "DUSSAN",
        "authorized_official_first_name": "ANGELA",
        "authorized_official_title_or_position": "OPTOMETRIST",
        "authorized_official_telephone_number": "347-242-3884",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03487065",
            "state": "NY"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://www.zocdoc.com/doctor/angela-dussan-od-161773",
            "affiliation": "N",
            "endpointDescription": "N/A",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "N/A",
            "address_1": "9741 Queens Blvd",
            "city": "Rego Park",
            "state": "NY",
            "country_code": "US",
            "postal_code": "113742103",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "A DUSSAN SERVICES LLC",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "A DUSSAN SERVICES LLC",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Dussan eye care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Long Island City, NY

All providers in Long Island City, NY · Optometrist in New York

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 28, 2019. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
Medicare Fee-For-Service Public Provider 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.