Marissa Cristina Povol, O.D.
Individual provider Active NPI Optometrist · Bayshore, NY
NPI 1922537463 · NPPES record last updated Feb 24, 2026
Key facts
- NPI
- 1922537463
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Optometrist 152W00000X
- License
- TUV-008625 (NY)
- Practice address
- 2 W Main Street
Bayshore, NY 11706 - Phone
- (631) 813-1112
- Fax
- (631) 206-9200
- NPI assigned
- Jun 8, 2017
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 3
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NY
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20180611002612 | NY | Practitioner - Optometry | 4587919766 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| TUV-008625 | NY | MD | Optometrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Medical Surgical Eye Care Services PC | Current |
Accepting new patients | |
| We Care for Eyes Inc | Current |
Accepting new patients | |
| DLJ Spectacles | Optometrist | Past | Accepting new patients |
Locations
150 Broadhollow Rd
Ste 108
Melville, NY 11747
Phone (631) 385-1400
360 Montauk Hwy
West Islip, NY 11795
Phone (631) 422-1110
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | TUV-008625 | NY | Yes |
Addresses
Primary practice location
2 W Main Street
Bayshore, NY 11706
Mailing address
21 Argyle Drive
East Islip, NY 11730
Phone (631) 871-5552
Other names
- Ms. Marissa Christina Koopman
Other providers in Bayshore, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 24, 2026. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.