Individual provider Active NPI

Sonya Braudway, O.D.

  • Optometrist
  • Winter Haven, FL
National Provider Identifier
1043282387
Registry record updated Jun 7, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
2743 Issued in FL
Practice address
250 Avenue K SW
Suite 200
Winter Haven, FL 33880-3914
Phone
(863) 297-5400
Fax
(863) 293-8230
NPI assigned
Feb 2, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 7, 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 2743 FL Primary

Addresses

Primary practice location

250 Avenue K SW
Suite 200
Winter Haven, FL 33880-3914

Mailing address

250 Ave K SW
#200
Winter Haven, FL 33880
Phone (863) 297-5400

Other identifiers 1

IdentifierTypeStateIssuer
620484800MedicaidFL

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
I20100920001221 FL Practitioner - Optometry 6002931508 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2743FLMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Eye Doctors Optical Outlets PA Optometrist CurrentSince Jan 20, 2013 Accepting new patients
Eye Doctors Optical Outlets PA Optometrist CurrentSince Jan 20, 2013 Accepting new patients
Eye Doctors Optical Outlets PA Optometrist Current Accepting new patients
Pennachio & Fishman M.D., P.a. Past Accepting new patients
Fishman & Sheridan MD PA PastSince Jul 22, 1996 Accepting new patients

Locations

1230 Posner Blvd
Davenport, FL 33837
Phone (863) 623-3155

5607 Johns Rd
Tampa, FL 33634
Phone (813) 385-1873

723 3rd St SW
Winter Haven, FL 33880
Phone (863) 297-5067

Networks

  • Freedom Health HMO Network

Interoperability endpoints

  • Direct secure messaging: sbraudway@crmd.emadirect.md

Organizations & group practices 5

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": "1138838400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1275868800000",
    "number": "1043282387",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "250 AVE K SW",
            "address_2": "#200",
            "city": "WINTER HAVEN",
            "state": "FL",
            "postal_code": "33880",
            "telephone_number": "863-297-5400",
            "fax_number": "863-293-9780"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "250 AVENUE K SW",
            "address_2": "SUITE 200",
            "city": "WINTER HAVEN",
            "state": "FL",
            "postal_code": "338803914",
            "telephone_number": "863-297-5400",
            "fax_number": "863-293-8230"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRAUDWAY",
        "first_name": "SONYA",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-02-02",
        "last_updated": "2010-06-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "FL",
            "license": "2743",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "620484800",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Winter Haven, FL

Sources for this page

Verify at the official NPI Registry.