Active NPI
Ragi Mamistvalov, OD
- Optometrist
- Holbrook, NY
National Provider Identifier
1871783472
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- TUV0064581
- Practice address
- 2707 Saddle Rock Road
Holbrook, NY 11741 - Phone
- (631) 319-1293
- NPI assigned
- Jul 30, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | TUV0064581 | NY | Primary |
Addresses
Primary practice location
2707 Saddle Rock Road
Holbrook, NY 11741
Mailing address
2707 Saddle Rock Road
Holbrook, NY 11741
Phone (631) 319-1293
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| TUV0064581 | NY | MD | Optometrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1185753600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1333411200000",
"number": "1871783472",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2707 SADDLE ROCK ROAD",
"city": "HOLBROOK",
"state": "NY",
"postal_code": "11741",
"telephone_number": "631-319-1293"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2707 SADDLE ROCK ROAD",
"city": "HOLBROOK",
"state": "NY",
"postal_code": "11741",
"telephone_number": "631-319-1293"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MAMISTVALOV",
"first_name": "RAGI",
"name_prefix": "Dr.",
"credential": "OD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-07-30",
"last_updated": "2012-04-03",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "NY",
"license": "TUV0064581",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Holbrook, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 3, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.