Mark Stadlen

Primary specialty

OptometristTaxonomy code 152W00000X

License

TUV0040201 Issued in NY

Practice address

3803 Broadway
Astoria, NY 11103-4058

Phone

(718) 956-3000

Fax

(718) 204-0227

NPI assigned

Feb 29, 2008

Last updated

Aug 26, 2021By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in NY

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 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• 200 West Optics, LLC

  dba MyEyeDr.

  • Optometrist
  • Brewster, NY
  • NPI 1831770890
  Medicare reassignment NPD
• American Eye Care Center, Inc.

  • Optometrist
  • Astoria, NY
  • NPI 1386713394
  Authorized official Same address or phone
• 200 West Optics, LLC

  dba MyEyeDr.

  • Optometrist
  • Astoria, NY
  • NPI 1104592278
  NPD
• 200 West Optics, LLC

  • Optometrist
  • New York, NY
  • NPI 1205787520
  NPD

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

{
    "created_epoch": "1204243200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1629936000000",
    "number": "1942479324",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1950 OLD GALLOWS RD STE 520",
            "city": "VIENNA",
            "state": "VA",
            "postal_code": "221823970",
            "telephone_number": "703-847-8899",
            "fax_number": "571-223-6780"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3803 BROADWAY",
            "city": "ASTORIA",
            "state": "NY",
            "postal_code": "111034058",
            "telephone_number": "718-956-3000",
            "fax_number": "718-204-0227"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STADLEN",
        "first_name": "MARK",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-02-29",
        "last_updated": "2021-08-26",
        "certification_date": "2021-08-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NY",
            "license": "TUV0040201",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00695345",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "MS0C329210",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Optometrist in Astoria, NY
• Providers in Astoria, NY by specialty
• Optometrist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.