Optimart, Inc.

Primary specialty

OpticianTaxonomy code 156FX1800X

License

OE386 Issued in FL

Legal business name

OPTIMART, INC.

Practice address

2637 E Gulf to Lake Hwy
Inverness, FL 34453-3216

Phone

(352) 637-5180

Fax

(352) 637-5181

NPI assigned

May 17, 2007

Organization subpart

No

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

Authorized official

Name

Gregory Louis Mathis

Title

Administrator

Phone

(727) 914-8615

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• OPTIMART, INC. #12 Doing business as

Locations

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

{
    "created_epoch": "1179360000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1593561600000",
    "number": "1013124882",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4359 35TH ST N",
            "city": "SAINT PETERSBURG",
            "state": "FL",
            "postal_code": "337143717",
            "telephone_number": "727-914-8615",
            "fax_number": "727-914-8610"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2637 E GULF TO LAKE HWY",
            "city": "INVERNESS",
            "state": "FL",
            "postal_code": "344533216",
            "telephone_number": "352-637-5180",
            "fax_number": "352-637-5181"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OPTIMART, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-17",
        "last_updated": "2020-07-01",
        "certification_date": "2020-07-01",
        "status": "A",
        "authorized_official_last_name": "MATHIS",
        "authorized_official_first_name": "GREGORY",
        "authorized_official_middle_name": "LOUIS",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "727-914-8615"
    },
    "taxonomies": [
        {
            "code": "156FX1800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Technician/Technologist, Optician",
            "state": "FL",
            "license": "OE386",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "630126600",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "OPTIMART, INC. #12",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "OPTIMART, INC. #12",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 1, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.