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MARTIN ALEX MUNDACKAL OD
NPI 1114816634
Optometrist in New York, NY

Active since June 30, 2025PECOS Enrolled
4204 BROADWAY, NEW YORK, NY 10033(917) 920-2636 Get Directions Write a Review

NPPES record last updated: July 7, 2025. Verified against the NPPES registry weekly; last sync: October 18, 2026.

Record update history: Jul 7, 2025, Jun 30, 2025 (2 updates tracked since 2025).

About Martin Alex Mundackal Od NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MARTIN ALEX MUNDACKAL OD (NPI 1114816634) is an individual optometrist in New York, New York, licensed in New York (011180) and active in the NPI registry since June 2025. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1114816634
Entity TypeIndividualMale
Primary Taxonomy152W00000X
Provider Legal NameMARTIN ALEX MUNDACKALCredential: OD
Location Address4204 BROADWAYNew York, NY 10033-3706
Mailing Address212 Benedict AveThornwood, NY 10594-1204 · (212) 433-0136
Phone(917) 920-2636
Sole ProprietorNo
Enumeration DateJune 30, 2025
Last NPPES UpdateJuly 7, 20252 updates tracked since enumeration
NPPES CertifiedJuly 7, 2025
✔ NPI 1114816634 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyOptometristEye and Vision Services Providers
Taxonomy Code152W00000X
License✔ Licensed in NY · 011180
Definition
Doctors of optometry (ODs) are the primary health care professionals for the eye. Optometrists examine, diagnose, treat, and manage diseases, injuries, and disorders of the visual system, the eye, and associated structures as well as identify related systemic conditions affecting the eye. An optometrist has completed pre-professional undergraduate education in a college or university and four years of professional education at a college of optometry, leading to the doctor of optometry (O.D.) degree. Some optometrists complete an optional residency in a specific area of practice. Optometrists are eye health care professionals state-licensed to diagnose and treat diseases and disorders of the eye and visual system.
4204 BROADWAY, New York, NY 10033
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Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Blue Cross and Blue Shield of Montana, Blue Cross and Blue Shield of Oklahoma, Blue Cross and Blue Shield of Texas.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Martin Alex Mundackal Od is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignment

Medicare enrollment records show Martin Mundackal reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Vistasite Optique Inc
Same address
Ophthalmologic Surgery
4204 BROADWAY
New York, NY 10033
  • Reassigned Medicare billing, New York enrollment
  • 3 clinicians in this Medicare group
NPI 1578052791 (917) 261-6100

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 10033 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$150.24 typical visit price
range $65.69 – $198.19
Typical copayment $37.56 (range $16.42 – $49.54)
Most-billed visit code 99204
Established Patient
$81.44 typical visit price
range $21.20 – $160.66
Typical copayment $20.36 (range $5.30 – $40.16)
Most-billed visit code 99213
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

VISTASITE OPTIQUE INC
Clinic/Center (Ophthalmologic Surgery)
4204 BROADWAY
NEW YORK, NY 10033
New York County (917) 261-6100

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Martin Mundackal's NPI number?

The NPI number for Martin Mundackal is 1114816634. It was assigned to this individual provider in the NPPES registry on June 30, 2025.

Where is Martin Mundackal located?

Martin Mundackal practices at 4204 Broadway, New York, NY 10033. The listed phone number is (917) 920-2636.

What is Martin Mundackal's specialty?

The primary specialty registered for this NPI is Optometrist with taxonomy code 152W00000X.

Is Martin Mundackal enrolled in Medicare?

Yes. Martin Mundackal is registered in the Medicare PECOS enrollment system.

Which organization bills Medicare for Martin Mundackal's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Martin Mundackal reassigns Medicare benefits to Vistasite Optique Inc (New York, NY). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Martin Mundackal's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

What insurance does Martin Mundackal accept?

Health plans from Blue Cross and Blue Shield of Montana, Blue Cross and Blue Shield of Oklahoma and Blue Cross and Blue Shield of Texas list Martin Mundackal as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Martin Mundackal was last updated on July 7, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 15 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.