Individual provider Active NPI

Rokhel Kaziyev, OD

  • Optometrist
  • Corona, NY
National Provider Identifier
1912568536
Registry record updated Jun 25, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
TUV008979 Issued in NY
Practice address
10306 Roosevelt Ave
Corona, NY 11368-2330
Phone
(718) 424-1333
NPI assigned
Jun 25, 2019
Last updated
Jun 25, 2019By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 25, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X TUV008979 NY Primary

Addresses

Primary practice location

10306 Roosevelt Ave
Corona, NY 11368-2330

Mailing address

9918 66TH Ave Apt 5a
Rego Park, NY 11374-3633

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY, GA2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20190710001398 NY Practitioner - Optometry 2860727039 Reassigns benefits to 1 organization
I20240314003532 GA Practitioner - Optometry 2860727039 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
TUV008979NYMDOptometrist
008979NYMDOccupational Therapy Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Ga Doctors of Optometry LLC Optometrist CurrentSince Feb 6, 2024 Accepting new patients
Pure Vision Optical LLC Optometrist CurrentSince Dec 1, 2020 Accepting new patients
Ga Doctors of Optometry LLC Optometrist CurrentSince Feb 6, 2024 Accepting new patients
20/15 Eyecare, LLC Optometrist CurrentSince Jul 23, 2024 Accepting new patients
Corona Optometry, PC Optometrist CurrentSince Jun 26, 2019 Accepting new patients
Oneopto Ga 1 PLLC Optometrist PastSince Jul 23, 2024 Accepting new patients
Corona Optometry PC Optometrist PastSince Jun 26, 2019 Accepting new patients

Locations

50 Main Street Market Pl SE
Ste 100
Cartersville, GA 30121
Phone (770) 382-6379

2090 Dunwoody Club Dr
Ste 126
Sandy Springs, GA 30350
Phone (770) 676-7848

10306 Roosevelt Ave
Corona, NY 11368
Phone (718) 424-1333

3781 Junction Blvd
Corona, NY 11368
Phone (718) 446-1333

10023 Queens Blvd
Forest Hills, NY 11375
Phone (718) 997-6500

Organizations & group practices 7

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

NPI Registry JSON

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

{
    "created_epoch": "1561420800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1561420800000",
    "number": "1912568536",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9918 66TH AVE APT 5A",
            "city": "REGO PARK",
            "state": "NY",
            "postal_code": "113743633"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10306 ROOSEVELT AVE",
            "city": "CORONA",
            "state": "NY",
            "postal_code": "113682330",
            "telephone_number": "718-424-1333"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KAZIYEV",
        "first_name": "ROKHEL",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-06-25",
        "last_updated": "2019-06-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NY",
            "license": "TUV008979",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Corona, NY

Sources for this page

Verify at the official NPI Registry.