Individual provider Active NPI

Elyse M Decker, O.D.

  • Optometrist
  • Bayside, NY
National Provider Identifier
1992753206
Registry record updated Oct 20, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
006919 Issued in NY
Practice address
4101 Bell Blvd
Bayside, NY 11361-2858
Phone
(718) 428-6700
NPI assigned
May 5, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 20, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 006919 NY Primary

Addresses

Primary practice location

4101 Bell Blvd
Bayside, NY 11361-2858

Mailing address

911 Midway
Woodmere, NY 11598-1526
Phone (516) 295-2810

Other identifiers 1

IdentifierTypeStateIssuer
02666815MedicaidNY

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20050817000143 NY Practitioner - Optometry 8820028160 Practice locations: Lynbrook, NY; Bayside, NY

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
State University of New York - State College Optometry, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

91 Broadway
Lynbrook, NY 11563-3234
Phone (516) 593-2888

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Danet Optical LTD Optometrist CurrentSince Jun 30, 2005 Accepting new patients
Midway Optics LTD Optometrist Current Accepting new patients
Bayside Vision Corp Optometrist PastSince Aug 6, 2023 Accepting new patients

Locations

4101 Bell Blvd
Flushing, NY 11361
Phone (718) 428-6700

91 Broadway
Lynbrook, NY 11563
Phone (516) 593-2888

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1146787200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1413763200000",
    "number": "1992753206",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "911 MIDWAY",
            "city": "WOODMERE",
            "state": "NY",
            "postal_code": "115981526",
            "telephone_number": "516-295-2810"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4101 BELL BLVD",
            "city": "BAYSIDE",
            "state": "NY",
            "postal_code": "113612858",
            "telephone_number": "718-428-6700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DECKER",
        "first_name": "ELYSE",
        "middle_name": "M",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-05",
        "last_updated": "2014-10-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NY",
            "license": "006919",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02666815",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bayside, NY

Sources for this page

Verify at the official NPI Registry.