Individual provider Active NPI

Gursewak Singh, OD

  • Optometrist
  • Brooklyn, NY
National Provider Identifier
1891476347
Registry record updated Jul 27, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
RT009862 Issued in NY
Practice address
457 Knickerbocker Ave
Brooklyn, NY 11237-5107
Phone
(718) 386-0021
NPI assigned
Jul 27, 2023
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 27, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X RT009862 NY Primary

Addresses

Primary practice location

457 Knickerbocker Ave
Brooklyn, NY 11237-5107

Mailing address

457 Knickerbocker Ave
Brooklyn, NY 11237-5107
Phone (718) 386-0021

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230915001471 NY Practitioner - Optometry 3274997895 Reassigns benefits to 3 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
RT009862NYMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Supreme Eyecare Center Corp Optometrist CurrentSince Aug 1, 2023 Accepting new patients
Crystal Eyewear Inc CurrentSince Oct 23, 2024 Accepting new patients
Liberty Optical Corp Optometrist CurrentSince Aug 1, 2023 Accepting new patients
Kraupner Pharmacy, Inc PastSince Jul 31, 2023 Accepting new patients

Locations

457 Knickerbocker Ave
Brooklyn, NY 11237
Phone (347) 635-0335

9015 Queens Blvd
Ste 1029
Elmhurst, NY 11373
Phone (718) 760-2020

12102 Liberty Ave
South Richmond Hill, NY 11419
Phone (718) 641-1160

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1690416000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1690416000000",
    "number": "1891476347",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "457 KNICKERBOCKER AVE",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112375107",
            "telephone_number": "718-386-0021"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "457 KNICKERBOCKER AVE",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112375107",
            "telephone_number": "718-386-0021"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SINGH",
        "first_name": "GURSEWAK",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-07-27",
        "last_updated": "2023-07-27",
        "certification_date": "2023-07-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NY",
            "license": "RT009862",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brooklyn, NY

Sources for this page

Verify at the official NPI Registry.