South Fork Optical Center, Inc.

Primary specialty

Eyewear SupplierTaxonomy code 332H00000X

License

4065 Issued in NY

Legal business name

SOUTH FORK OPTICAL CENTER, INC.

Practice address

1 Jackson Ave South
Hampton Bays, NY 11946-2018

Phone

(631) 728-1525

Fax

(631) 728-1534

NPI assigned

Sep 27, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Alex Tschubarjan, O.D.NPI 1043351968

Title

Doctor/Owner

Phone

(631) 728-1525

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Alex Tschubarjan, O.D.

  • Optometrist
  • Hampton Bays, NY
  • NPI 1043351968
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1190851200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1203984000000",
    "number": "1891982476",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 JACKSON AVE",
            "city": "HAMPTON BAYS",
            "state": "NY",
            "postal_code": "119462018",
            "telephone_number": "631-728-1525",
            "fax_number": "631-728-1534"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 JACKSON AVE SOUTH",
            "city": "HAMPTON BAYS",
            "state": "NY",
            "postal_code": "119462018",
            "telephone_number": "631-728-1525",
            "fax_number": "631-728-1534"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH FORK OPTICAL CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-09-27",
        "last_updated": "2008-02-26",
        "status": "A",
        "authorized_official_last_name": "TSCHUBARJAN",
        "authorized_official_first_name": "ALEX",
        "authorized_official_title_or_position": "DOCTOR/OWNER",
        "authorized_official_telephone_number": "631-728-1525",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "332H00000X",
            "taxonomy_group": "",
            "desc": "Eyewear Supplier",
            "state": "NY",
            "license": "4065",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Amandeep Kaur Sidhu, PHARMD
• Kelly Silvera, MD
• Hana Rose Simpson-Heavey
• Mary Beth Somma, RN
• Pirjo Sorgi, NP
• South Fork Podiatry PC
• Southampton Pediatric Associates PC
• Brooke Sparacio
• Maureen Elizabeth Stefanidis
• Joanne Marie Taylor, REGISTERED NURSE

• Eyewear Supplier in Hampton Bays, NY
• Providers in Hampton Bays, NY by specialty
• Eyewear Supplier in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 26, 2008; 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.