NPIMap

Organization Active NPI

SVC of Fresh Meadows LLC

  • Optometrist
  • Fresh Meadows, NY
National Provider Identifier
1891398384
Registry record updated Dec 3, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
Legal business name
SVC OF FRESH MEADOWS LLC
Practice address
6130A 190TH St
Fresh Meadows, NY 11365-2721
Phone
(718) 454-8484
NPI assigned
Nov 18, 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 S Williams Jr., OD
Title
Owner
Phone
(631) 422-2442

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X NU Primary
Eyewear Supplier 332H00000X NU

Addresses

Primary practice location

6130A 190TH St
Fresh Meadows, NY 11365-2721

Mailing address

1224 Ostrander Avenue
Riverhead, NY 11901
Phone (631) 727-2858

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210126000738 NY Part B Supplier - Clinic/Group Practice 0648684001 Receives reassigned benefits from 13 practitioners
Practice locations: Fresh Meadows, NY

National Provider Directory

National Provider Directory

Locations

6130A 190th St
Fresh Meadows, NY 11365
Phone (718) 454-8484

Practitioners & affiliated clinicians

Practitioners 16

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.

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1605657600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1606953600000",
    "number": "1891398384",
    "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",
            "telephone_number": "631-727-2858"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6130A 190TH ST",
            "city": "FRESH MEADOWS",
            "state": "NY",
            "postal_code": "113652721",
            "telephone_number": "718-454-8484"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SVC OF FRESH MEADOWS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-11-18",
        "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": "S",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "631-422-2442",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "332H00000X",
            "taxonomy_group": "",
            "desc": "Eyewear Supplier",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fresh Meadows, 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.