Active NPI
Nyc Optical Group LLC
- Optometrist
- Brooklyn, NY
National Provider Identifier
1861983397
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- T005287
- Legal business name
- NYC OPTICAL GROUP LLC
- Practice address
- 1354 Pennsylvania Ave
Brooklyn, NY 11239-2111 - Phone
- (718) 642-3526
- Fax
- (718) 642-3496
- NPI assigned
- May 21, 2018
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Andrey Gan
- Title
- Owner
- Phone
- (718) 902-9592
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | T005287 | NY | Primary |
Addresses
Primary practice location
1354 Pennsylvania Ave
Brooklyn, NY 11239-2111
Mailing address
2580 Ocean Pkwy Apt 6N
Brooklyn, NY 11235-7736
Phone (718) 757-9266
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NY
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20190614001722 | NY | Part B Supplier - Clinic/Group Practice | 8123351665 |
Receives reassigned benefits from 7 practitioners 6 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Brooklyn, NY; Bronx, NY |
Other NPIs on the same Medicare enrollment 4
NPIs listed together on one Medicare enrollment, typically parts of the same organization.
National Provider Directory
National Provider DirectoryNPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1526860800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1670371200000",
"number": "1861983397",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2580 OCEAN PKWY APT 6N",
"city": "BROOKLYN",
"state": "NY",
"postal_code": "112357736",
"telephone_number": "718-757-9266"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1354 PENNSYLVANIA AVE",
"city": "BROOKLYN",
"state": "NY",
"postal_code": "112392111",
"telephone_number": "718-642-3526",
"fax_number": "718-642-3496"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "NYC OPTICAL GROUP LLC",
"organizational_subpart": "NO",
"enumeration_date": "2018-05-21",
"last_updated": "2022-12-07",
"certification_date": "2022-12-07",
"status": "A",
"authorized_official_last_name": "GAN",
"authorized_official_first_name": "ANDREY",
"authorized_official_title_or_position": "OWNER",
"authorized_official_telephone_number": "718-902-9592"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
"desc": "Optometrist",
"state": "NY",
"license": "T005287",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Brooklyn, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 7, 2022; 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.