NPIMap

Organization Active NPI

SVC of Riverhead LLC

  • Optometrist
  • Riverhead, NY
National Provider Identifier
1881221695
Registry record updated Dec 3, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
Legal business name
SVC OF RIVERHEAD LLC
Practice address
1224 Ostrander Avenue
Riverhead, NY 11901
Phone
(631) 727-2858
Fax
(631) 727-2866
NPI assigned
Mar 24, 2020
Last updated
Dec 3, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 3, 2020

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

Authorized official

Name
Jeffrey Slaney Williams
Title
Owner
Phone
(631) 727-2858

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X Primary

Addresses

Primary practice location

1224 Ostrander Avenue
Riverhead, NY 11901

Mailing address

1224 Ostrander Avenue
Riverhead, NY 11901

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200402000550 NY Part B Supplier - Clinic/Group Practice 8921437500 Receives reassigned benefits from 7 practitioners
Practice locations: Riverhead, NY

National Provider Directory

National Provider Directory
Tax ID family
Sound Vision Care2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

887 Old Country Rd
Ste Gkl
Riverhead, NY 11901
Phone (631) 727-2858

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1585008000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1606953600000",
    "number": "1881221695",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1224 OSTRANDER AVENUE",
            "city": "RIVERHEAD",
            "state": "NY",
            "postal_code": "11901"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1224 OSTRANDER AVENUE",
            "city": "RIVERHEAD",
            "state": "NY",
            "postal_code": "11901",
            "telephone_number": "631-727-2858",
            "fax_number": "631-727-2866"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SVC OF RIVERHEAD LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-03-24",
        "last_updated": "2020-12-03",
        "certification_date": "2020-12-01",
        "status": "A",
        "authorized_official_last_name": "WILLIAMS",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_middle_name": "SLANEY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "631-727-2858"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Riverhead, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 3, 2020; 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.