NPIMap

Organization Active NPI

Andreanos Jordanopoulos OD Inc

  • Optometrist
  • West Melbourne, FL
National Provider Identifier
1104911098
Registry record updated Jun 11, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
FL2531 Issued in FL
Legal business name
ANDREANOS JORDANOPOULOS OD INC
Practice address
1573 South Wickham Road
West Melbourne, FL 32904-3540
Phone
(321) 723-8115
Fax
(321) 723-7388
NPI assigned
Oct 4, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 11, 2008

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

Authorized official

Name
Andreanos Jordanopoulos, ODNPI 1265613186
Title
President Owner Optometrist
Phone
(321) 723-8115

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193200000X MULTI-SPECIALTY GROUP 152W00000X FL2531 FL Primary

Addresses

Primary practice location

1573 South Wickham Road
West Melbourne, FL 32904-3540

Mailing address

1573 South Wickham Road
West Melbourne, FL 32904-3540
Phone (321) 723-8115

Other identifiers 1

IdentifierTypeStateIssuer
K6081OtherFLMEDICARE GROUP NUMBER

Other names 1

  • Eyecare Plus Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040902000875 FL Part B Supplier - Clinic/Group Practice 4688640550 Receives reassigned benefits from 1 practitioner
Practice locations: Titusville, FL

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1159920000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1213142400000",
    "number": "1104911098",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1573 SOUTH WICKHAM ROAD",
            "city": "WEST MELBOURNE",
            "state": "FL",
            "postal_code": "329043540",
            "telephone_number": "321-723-8115",
            "fax_number": "321-723-7388"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1573 SOUTH WICKHAM ROAD",
            "city": "WEST MELBOURNE",
            "state": "FL",
            "postal_code": "329043540",
            "telephone_number": "321-723-8115",
            "fax_number": "321-723-7388"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ANDREANOS JORDANOPOULOS OD INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-04",
        "last_updated": "2008-06-11",
        "status": "A",
        "authorized_official_last_name": "JORDANOPOULOS",
        "authorized_official_first_name": "ANDREANOS",
        "authorized_official_title_or_position": "PRESIDENT OWNER OPTOMETRIST",
        "authorized_official_telephone_number": "321-723-8115",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": "FL",
            "license": "FL2531",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP NUMBER",
            "identifier": "K6081",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Eyecare Plus",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in West Melbourne, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2008; 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.