Individual provider Active NPI

Mona A Henri, O.D.

  • Optometrist
  • St Petersburg, FL
National Provider Identifier
1003818915
Registry record updated Sep 11, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
OPC2526 Issued in FL
Practice address
2201 4TH St N Ste a
St Petersburg, FL 33704-4300
Phone
(727) 894-0500
Fax
(727) 823-8697
NPI assigned
Aug 10, 2005
Last updated
Sep 11, 2013By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 11, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X OPC2526 FL Primary

Addresses

Primary practice location

2201 4TH St N Ste a
St Petersburg, FL 33704-4300

Mailing address

2201 4TH St N Ste a
St Petersburg, FL 33704-4300
Phone (727) 894-0500

Other identifiers 1

IdentifierTypeStateIssuer
078852000MedicaidFL

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
I20040628000660 FL Practitioner - Optometry 9537145859 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
OPC2526FLMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Vip Eye Care and Optical Boutique at Carillon LLC Optometrist CurrentSince Jun 19, 2023 Accepting new patients
Optometric Associates of Florida, P.a. Optometrist Past Accepting new patients
Jennifer L Manning OD PA Optometrist PastSince Sep 24, 2013 Accepting new patients

Locations

12425 28th St N
Ste 103
St Petersburg, FL 33716
Phone (727) 295-0500

Organizations & group practices 4

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

NPI Registry JSON

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

{
    "created_epoch": "1123632000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1378857600000",
    "number": "1003818915",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2201 4TH ST N STE A",
            "city": "ST PETERSBURG",
            "state": "FL",
            "postal_code": "337044300",
            "telephone_number": "727-894-0500",
            "fax_number": "727-823-8697"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2201 4TH ST N STE A",
            "city": "ST PETERSBURG",
            "state": "FL",
            "postal_code": "337044300",
            "telephone_number": "727-894-0500",
            "fax_number": "727-823-8697"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HENRI",
        "first_name": "MONA",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2005-08-10",
        "last_updated": "2013-09-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "FL",
            "license": "OPC2526",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "078852000",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in St Petersburg, FL

Sources for this page

Verify at the official NPI Registry.