Individual provider Active NPI

Edward Attaway, O.D.

  • Optometrist
  • Winter Haven, FL
National Provider Identifier
1003810367
Registry record updated Feb 9, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
OPC 2010 Issued in FL
Practice address
407 Avenue K SE
Winter Haven, FL 33880-4126
Phone
(863) 294-3504
Fax
(863) 294-8305
NPI assigned
Jun 2, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 9, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X OPC 2010 FL Primary

Addresses

Primary practice location

407 Avenue K SE
Winter Haven, FL 33880-4126

Mailing address

407 Avenue K SE
Winter Haven, FL 33880-4126
Phone (863) 294-3504

Other identifiers 1

IdentifierTypeStateIssuer
078605500MedicaidFL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
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
I20100212000291 FL Practitioner - Optometry 0143364257 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
University of Houston - College of Optometry, 1981
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Eye Specialists of Mid Florida PAGroup PAC ID 8022003235, 15 clinicians

Practice addresses (Care Compare)

407 Ave K SE
Winter Haven, FL 33880-4126
Phone 86329435041280

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
OPC 2010FLMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Eye Specialists of Mid Florida, PA CurrentSince Sep 8, 1998 Accepting new patients
Eye Specialists of Mid Florida PA Optometrist CurrentSince Sep 8, 1998 Accepting new patients
Eye Specialists of Mid Florida, PA Past Accepting new patients

Locations

202 Magnolia Ave
Auburndale, FL 33823
Phone (863) 294-3504

1050 US Highway 27
Ste 1
Clermont, FL 34714
Phone (352) 394-8705

100 Patterson Rd
Haines City, FL 33844
Phone (863) 294-3504

2800 Ridge Way
Ste 100
Lake Wales, FL 33859
Phone (863) 676-2008

3350 Harden Blvd
Lakeland, FL 33803
Phone (863) 294-3504

2004 E County Road 540A
Lakeland, FL 33813
Phone (863) 294-3504

5032 US 27 N
Sebring, FL 33870
Phone (863) 382-3900

407 Avenue K SE
Winter Haven, FL 33880
Phone (863) 294-3504

Interoperability endpoints

  • Direct secure messaging: edward.attaway@esmf.direct.eyemdemr.com

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": "1117670400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1265673600000",
    "number": "1003810367",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "407 AVENUE K SE",
            "city": "WINTER HAVEN",
            "state": "FL",
            "postal_code": "338804126",
            "telephone_number": "863-294-3504",
            "fax_number": "863-294-8305"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "407 AVENUE K SE",
            "city": "WINTER HAVEN",
            "state": "FL",
            "postal_code": "338804126",
            "telephone_number": "863-294-3504",
            "fax_number": "863-294-8305"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ATTAWAY",
        "first_name": "EDWARD",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-02",
        "last_updated": "2010-02-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "FL",
            "license": "OPC 2010",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "078605500",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Winter Haven, FL

Sources for this page

Verify at the official NPI Registry.