Active NPI
Breanna Lynn Burgenstock
- Optician
- Watertown, NY
National Provider Identifier
1982111803
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optician
- License
- 8463-1
- Practice address
- 20823 Nys RT 3
Watertown, NY 13601-5577 - Phone
- (315) 788-1570
- NPI assigned
- Dec 30, 2017
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optician | 156FX1800X | 8463-1 | NY | Primary |
Addresses
Primary practice location
20823 Nys RT 3
Watertown, NY 13601-5577
Mailing address
20823 Nys RT 3
Watertown, NY 13601-5577
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 207069530 | Medicaid | NY |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 8463-1 | NY | MD | Optician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1514592000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1529107200000",
"number": "1982111803",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "20823 NYS RT 3",
"city": "WATERTOWN",
"state": "NY",
"postal_code": "136015577"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "20823 NYS RT 3",
"city": "WATERTOWN",
"state": "NY",
"postal_code": "136015577",
"telephone_number": "315-788-1570"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BURGENSTOCK",
"first_name": "BREANNA",
"middle_name": "LYNN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-12-30",
"last_updated": "2018-06-16",
"status": "A"
},
"taxonomies": [
{
"code": "156FX1800X",
"taxonomy_group": "",
"desc": "Technician/Technologist, Optician",
"state": "NY",
"license": "8463-1",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "207069530",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Watertown, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.