SVC of Port Jefferson Station, LLC

Primary specialty

OptometristTaxonomy code 152W00000X

Legal business name

SVC OF PORT JEFFERSON STATION, LLC

Practice address

524 Patchogue Rd
Port Jefferson Station, NY 11776

Phone

(631) 476-4707

Fax

(631) 727-2866

NPI assigned

Jun 21, 2021

Organization subpart

No

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

Authorized official

Name

Jeffrey Williams Jr., OD

Title

OD, Owner

Phone

(631) 727-2858

Specialties & licenses 2

Addresses

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

{
    "created_epoch": "1624233600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1624233600000",
    "number": "1962071258",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1224 OSTRANDER AVE",
            "city": "RIVERHEAD",
            "state": "NY",
            "postal_code": "119012109",
            "telephone_number": "631-727-2858",
            "fax_number": "631-727-2866"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "524 PATCHOGUE RD",
            "city": "PORT JEFFERSON STATION",
            "state": "NY",
            "postal_code": "11776",
            "telephone_number": "631-476-4707",
            "fax_number": "631-727-2866"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SVC OF PORT JEFFERSON STATION, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-06-21",
        "last_updated": "2021-06-21",
        "certification_date": "2021-06-03",
        "status": "A",
        "authorized_official_last_name": "WILLIAMS",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_title_or_position": "OD, OWNER",
        "authorized_official_telephone_number": "631-727-2858",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "332H00000X",
            "taxonomy_group": "",
            "desc": "Eyewear Supplier",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• John Paul Sugrue, M.D.
• Kelly Sullivan, RN
• Sup Acupuncture PLLC
• Ann Marie Sutter, M.S. C.C.C.
• Robin I Suydam, LPN
• Christine Svetina
• Samantha Lynn Sweeney, LCSW
• Mauricio Szuchmacher, M.D.
• Adina Sara Tabor, LCSW, LICSW
• Dorothy Janice Tambasco, LPN

• Optometrist in Port Jefferson Station, NY
• Providers in Port Jefferson Station, NY by specialty
• Optometrist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 21, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.