Active NPI
Daniel Lack, O.D.
- Vision Therapy Optometrist
- Lake Katrine, NY
National Provider Identifier
1902861685
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Vision Therapy Optometrist
- License
- TUV003890
- Practice address
- 117 Penstock LN
Lake Katrine, NY 12449-5240 - Phone
- (845) 336-6124
- NPI assigned
- Apr 18, 2006
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Vision Therapy Optometrist | 152WV0400X | TUV003890 | NY | Primary |
Addresses
Primary practice location
117 Penstock LN
Lake Katrine, NY 12449-5240
Mailing address
117 Penstock LN
Lake Katrine, NY 12449-5240
Phone (845) 336-6124
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 01125268 | Medicaid | NY |
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 |
|---|---|---|---|
| TUV003890 | NY | MD | Vision Therapy Optometrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1145318400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1902861685",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "117 PENSTOCK LN",
"city": "LAKE KATRINE",
"state": "NY",
"postal_code": "124495240",
"telephone_number": "845-336-6124"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "117 PENSTOCK LN",
"city": "LAKE KATRINE",
"state": "NY",
"postal_code": "124495240",
"telephone_number": "845-336-6124"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LACK",
"first_name": "DANIEL",
"name_prefix": "Dr.",
"credential": "O.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-04-18",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "152WV0400X",
"taxonomy_group": "",
"desc": "Optometrist, Vision Therapy",
"state": "NY",
"license": "TUV003890",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "01125268",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Lake Katrine, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.