Organization Active NPI

Optical Choice Corp

  • Optician
  • Forest Hills, NY
National Provider Identifier
1922104785
Registry record updated Aug 26, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
OpticianTaxonomy code 156FX1800X
License
007169-1 Issued in NY
Legal business name
OPTICAL CHOICE CORP
Practice address
11811 Queens Blvd
Forest Hills, NY 11375-7202
Phone
(718) 793-2461
NPI assigned
Sep 16, 2006
Last updated
Aug 26, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 26, 2010

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

Authorized official

Name
Mr. Pinkhoz YusupovNPI 1750362521
Title
Owner
Phone
(718) 793-2461

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optician 156FX1800X 007169-1 NY Primary

Addresses

Primary practice location

11811 Queens Blvd
Forest Hills, NY 11375-7202

Mailing address

11811 Queens Blvd
Forest Hills, NY 11375-7202

Other identifiers 1

IdentifierTypeStateIssuer
02245238MedicaidNY

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050617000795 NY Part B Supplier - Clinic/Group Practice 8527002799 Receives reassigned benefits from 1 practitioner
Practice locations: Forest Hills, NY

National Provider Directory

National Provider Directory

Locations

11811 Queens Blvd
Forest Hills, NY 11375
Phone (718) 793-2461

Practitioners & affiliated clinicians

Practitioners 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1158364800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1282780800000",
    "number": "1922104785",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11811 QUEENS BLVD",
            "city": "FOREST HILLS",
            "state": "NY",
            "postal_code": "113757202"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11811 QUEENS BLVD",
            "city": "FOREST HILLS",
            "state": "NY",
            "postal_code": "113757202",
            "telephone_number": "718-793-2461"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OPTICAL CHOICE CORP",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-16",
        "last_updated": "2010-08-26",
        "status": "A",
        "authorized_official_last_name": "YUSUPOV",
        "authorized_official_first_name": "PINKHOZ",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "718-793-2461",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "156FX1800X",
            "taxonomy_group": "",
            "desc": "Technician/Technologist, Optician",
            "state": "NY",
            "license": "007169-1",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02245238",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Forest Hills, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2010; 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.