Couzens Stam Domingo PA

Primary specialty

OptometristTaxonomy code 152W00000X

License

OPC 3453 Issued in FL

Legal business name

COUZENS STAM DOMINGO PA

Doing business as

Beaches Family Eye Care

Practice address

905 Beach Blvd
Suite B
Jacksonville Beach, FL 32250-4303

Phone

(904) 246-4831

Fax

(904) 249-5876

NPI assigned

Feb 5, 2007

Last updated

Nov 16, 2007By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Bryan Andrew Stam, O.D.NPI 1245239581

Title

President

Phone

(904) 246-4831

Specialties & licenses 1

Addresses

Other names 1

• Beaches Family Eye Care Doing business as

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Bryan Andrew Stam, O.D.

  • Optometrist
  • Jacksonville, FL
  • NPI 1245239581
  Medicare reassignment NPD Authorized official
• Cindy Marie Couzens, O.D.

  • Optometrist
  • Jacksonville, FL
  • NPI 1063534576
  NPD (past)
• Patrick J Domingo, OD

  • Optometrist
  • Jacksonville, FL
  • NPI 1922082882
  NPD (past)

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

{
    "created_epoch": "1170633600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1195171200000",
    "number": "1003955568",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "905 BEACH BLVD",
            "address_2": "SUITE B",
            "city": "JACKSONVILLE BEACH",
            "state": "FL",
            "postal_code": "322504303",
            "telephone_number": "904-246-4831",
            "fax_number": "904-249-5876"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "905 BEACH BLVD",
            "address_2": "SUITE B",
            "city": "JACKSONVILLE BEACH",
            "state": "FL",
            "postal_code": "322504303",
            "telephone_number": "904-246-4831",
            "fax_number": "904-249-5876"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COUZENS STAM DOMINGO PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-05",
        "last_updated": "2007-11-16",
        "status": "A",
        "authorized_official_last_name": "STAM",
        "authorized_official_first_name": "BRYAN",
        "authorized_official_middle_name": "ANDREW",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "904-246-4831",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "FL",
            "license": "OPC 3453",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Beaches Family Eye Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Tara Cooper, HEALTH COACH
• Alicia Sanders Corbin, M.ED. CCC-SLP
• Core Essentials Physical Therapy & Wellness, LLC
• Coremotion Wellness (COREmotion Pilates & Physical Therapy)
• Corporate Health LLC
• Kelly Cox
• Marcus Jeremy Cox, MD
• Stephanie Margaret-Timbol Cox, MS, LMHC
• Alexandra Crafton, L.AC.
• Caroline Craig

• Optometrist in Jacksonville Beach, FL
• Providers in Jacksonville Beach, FL by specialty
• Optometrist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 16, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.