Midcrest Optical Corporation

Primary specialty

OptometristTaxonomy code 152W00000X

License

VUT002933-1 Issued in NY

Legal business name

MIDCREST OPTICAL CORPORATION

Practice address

897 8TH Ave
New York, NY 10019-5154

Phone

(212) 582-5926

NPI assigned

May 30, 2007

Organization subpart

No

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

Authorized official

Name

Mr. Douglas Berger

Title

Director of Operations

Phone

(212) 582-5926

Specialties & licenses 8

Addresses

Other identifiers 1

Other names 1

• Creston Optical Doing business as

Locations

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

{
    "created_epoch": "1180483200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1318204800000",
    "number": "1982805750",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "897 8TH AVE",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100195154",
            "telephone_number": "212-582-5926"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "897 8TH AVE",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100195154",
            "telephone_number": "212-582-5926"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIDCREST OPTICAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-30",
        "last_updated": "2011-10-10",
        "status": "A",
        "authorized_official_last_name": "BERGER",
        "authorized_official_first_name": "DOUGLAS",
        "authorized_official_title_or_position": "DIRECTOR OF OPERATIONS",
        "authorized_official_telephone_number": "212-582-5926",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": "NY",
            "license": "VUT002933-1",
            "primary": true
        },
        {
            "code": "152WC0802X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist, Corneal and Contact Management",
            "state": "NY",
            "license": "VUT002933-1",
            "primary": false
        },
        {
            "code": "152WP0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist, Pediatrics",
            "state": "NY",
            "license": "VUT002933-1",
            "primary": false
        },
        {
            "code": "152WS0006X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist, Sports Vision",
            "state": "NY",
            "license": "VUT002933-1",
            "primary": false
        },
        {
            "code": "152WX0102X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist, Occupational Vision",
            "state": "NY",
            "license": "VUT002933-1",
            "primary": false
        },
        {
            "code": "156FC0801X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Technician/Technologist, Contact Lens Fitter",
            "state": "NY",
            "license": "5104-1",
            "primary": false
        },
        {
            "code": "156FX1800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Technician/Technologist, Optician",
            "state": "NY",
            "license": "005104-1",
            "primary": false
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "NY",
            "license": "C005104-1",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00328267",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Creston Optical",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 10, 2011; 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.