Active NPI
Paul Desantis, OD
- Optometrist
- Port St Lucie, FL
National Provider Identifier
1033733720
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- OPC-5767
- Practice address
- 1850 SW Gatlin Blvd
Port St Lucie, FL 34953-2703 - Phone
- (772) 336-9281
- NPI assigned
- May 29, 2020
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | OPC-5767 | FL | Primary |
Addresses
Primary practice location
1850 SW Gatlin Blvd
Port St Lucie, FL 34953-2703
Mailing address
7835 Saddlebrook Dr
Port Saint Lucie, FL 34986-3130
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| OPC-5767 | FL | MD | Optometrist |
Networks
- Freedom Health HMO Network
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1590710400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1632355200000",
"number": "1033733720",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7835 SADDLEBROOK DR",
"city": "PORT SAINT LUCIE",
"state": "FL",
"postal_code": "349863130"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1850 SW GATLIN BLVD",
"city": "PORT ST LUCIE",
"state": "FL",
"postal_code": "349532703",
"telephone_number": "772-336-9281"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DESANTIS",
"first_name": "PAUL",
"credential": "OD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2020-05-29",
"last_updated": "2021-09-23",
"certification_date": "2021-09-23",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "FL",
"license": "OPC-5767",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Port St Lucie, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.