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BROCKPORT OPTOMETRY, PC
NPI 1912112889
Optometrist in Brockport, NY

Active since May 13, 2007CLIA 33D2113966 · Waiver
22 N MAIN ST, LOWER SUITE, BROCKPORT, NY 14420(585) 637-2121(585) 637-7722 Get Directions Write a Review

NPPES record last updated: July 30, 2008. Verified against the NPPES registry weekly; last sync: October 25, 2026.

About Brockport Optometry, Pc NPPES

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

BROCKPORT OPTOMETRY, PC (NPI 1912112889) is a healthcare organization registered as an optometrist in Brockport, New York and active in the NPI registry since May 2007. The organization holds a CLIA Waiver certificate valid through June 2, 2028 and lists Michael Lee Raff, President, as its authorized official.

NPPES Registry Identity

NPI1912112889
Entity TypeOrganization
Primary Taxonomy152W00000X
Legal Business NameBROCKPORT OPTOMETRY, PC
Location Address22 N MAIN ST, LOWER SUITEBrockport, NY 14420-1614
Mailing Address38 Farm Field LnPittsford, NY 14534-2865 · (585) 248-2141
Phone(585) 637-2121
Fax(585) 637-7722
Organization SubpartNo
Authorized OfficialMichael Lee RaffPresident · (585) 637-2121
Enumeration DateMay 13, 2007
Last NPPES UpdateJuly 30, 2008
✔ NPI 1912112889 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyOptometristEye and Vision Services Providers
Taxonomy Code152W00000X
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.
22 N MAIN ST, Brockport, NY 14420
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Other Identifiers 3

Medicare UPINT25904NY
Medicare PIN14106ANY
Medicare NSC1149880001NY

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Blue Cross and Blue Shield of Louisiana, Blue Cross Blue Shield of Wyoming, Oscar Health.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Brockport Optometry, Pc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

Medicare enrollment records show 1 clinician reassigns Medicare billing to Brockport Optometry, PC, which bills Medicare for the services this clinician delivers.

Clinician (1)

Michael Raff, OD
Optometry
NPI 1609831080
22 N MAIN ST LOWER SUITE
Brockport, NY 14420
(585) 637-2121
✔ PECOS✔ Accepts MedicareSame address

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

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 33D2113966

Brockport Optometry, PC · Brockport, NY
Active · expires Jun 2, 2028
CLIA Number33D2113966
Laboratory TypePhysician Office
Certificate Effective DateJune 3, 2026
Certificate Expiration DateJune 2, 2028
Laboratory DirectorDr. Michael L. Raff
Laboratory Phone(585) 637-2121
Laboratory LocationBrockport Optometry, PC22 North Main Street - Lower Suite, Brockport, NY 14420
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Medical Equipment Supplier Medicare DMEPOS 3

Medicare supplier enrollment and the product categories Brockport Optometry, PC carries, from the Medicare DMEPOS supplier directory.

Brockport Optometry, PC

DMEPOS supplier · Brockport, NY
✔

Accepts Medicare assignment

Brockport Optometry, PC agrees to accept the Medicare-approved amount as full payment for covered equipment and supplies. Medicare patients are not billed beyond the standard deductible and coinsurance.

PTAN (Medicare Supplier Number)20666153
Medicare Participant SinceFebruary 3, 1997
Supplier Location22 N Main St Lowr SuiteBrockport, NY 14420
Phone(585) 637-2121
Supplier Specialties
Optometrist

Medicare Product Categories

Prosthetic Lenses: Conventional Eyeglasses
Conventional Eyeglasses
Prosthetic Lenses: Conventional Contact Lenses
Conventional Contact Lenses
Prosthetic Lenses: Prosthetics Cataract Lenses
Cataract Eyeglasses
Product categories are from the Medicare DMEPOS supplier directory. Contact the supplier to confirm current availability of specific items.

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 Brockport Optometry, PC's NPI number?

The NPI number for Brockport Optometry, PC is 1912112889. It was assigned to this organization in the NPPES registry on May 13, 2007.

Where is Brockport Optometry, PC located?

Brockport Optometry, PC is located at 22 N Main St Lower Suite, Brockport, NY 14420. The listed phone number is (585) 637-2121.

What is Brockport Optometry, PC's specialty?

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

Is Brockport Optometry, PC enrolled in Medicare?

Yes. Brockport Optometry, PC is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Brockport Optometry, PC?

According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Optometry) reassigns their Medicare billing to Brockport Optometry, PC. A 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 the clinician's services. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Does Brockport Optometry, PC accept Medicare assignment for medical equipment?

Yes. As a Medicare medical equipment supplier, Brockport Optometry, PC accepts Medicare assignment: the supplier accepts the Medicare-approved amount as payment in full for covered equipment and supplies.

Does Brockport Optometry, PC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 33D2113966) is associated with this NPI, valid through June 2, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

What insurance does Brockport Optometry, PC accept?

Health plans from Blue Cross Blue Shield of Wyoming, Blue Cross and Blue Shield of Louisiana and Oscar Health list Brockport Optometry, PC 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 Brockport Optometry, PC was last updated on July 30, 2008. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 18 years 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.