Organization Active NPI

Tri County Eye Associates PA

  • Optometrist
  • St Augustine, FL
National Provider Identifier
1114083367
Registry record updated Aug 17, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
OPC2080 Issued in FL
Legal business name
TRI COUNTY EYE ASSOCIATES PA
Practice address
25 Deltona Blvd
Suite 1
St Augustine, FL 32086-4204
Phone
(904) 797-5760
Fax
(904) 797-5762
NPI assigned
Dec 29, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 17, 2023

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

Authorized official

Name
Henry E. Miles, O.D.NPI 1295754182
Title
Owner
Phone
(904) 797-5760

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: 193400000X SINGLE SPECIALTY GROUP 152W00000X OPC2080 FL Primary

Addresses

Primary practice location

25 Deltona Blvd
Suite 1
St Augustine, FL 32086-4204

Mailing address

25 Deltona Blvd
Suite 1
St Augustine, FL 32086-4204
Phone (904) 797-5760

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20070626000368 FL Part B Supplier - Clinic/Group Practice 1951400324 Receives reassigned benefits from 6 practitioners
Practice locations: Palatka, FL; St Augustine, FL
O20100930047303 FL DME Supplier - Physician - Optometrist 1951400324 Practice locations: St Augustine, FL

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Tri County Eye Associates PA25 Deltona Blvd, St Augustine, FL 32086-4204(904) 797-5760 Prosthetic Lenses: Conventional Eyeglasses Accepts assignmentParticipating since Jan 1, 2007

National Provider Directory

National Provider Directory
Tax ID family
Tri County Eye Associates PA3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1403 Dunn Ave
Ste 5
Jacksonville, FL 32218
Phone (904) 696-0883

3506 Saint Johns Ave
Palatka, FL 32177
Phone (386) 328-4456

25 Deltona Blvd
Ste 1
St Augustine, FL 32086
Phone (904) 797-5760

Practitioners & affiliated clinicians

Practitioners 6

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": "1167350400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1692230400000",
    "number": "1114083367",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25 DELTONA BLVD",
            "address_2": "SUITE 1",
            "city": "ST AUGUSTINE",
            "state": "FL",
            "postal_code": "320864204",
            "telephone_number": "904-797-5760",
            "fax_number": "904-797-5762"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25 DELTONA BLVD",
            "address_2": "SUITE 1",
            "city": "ST AUGUSTINE",
            "state": "FL",
            "postal_code": "320864204",
            "telephone_number": "904-797-5760",
            "fax_number": "904-797-5762"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRI COUNTY EYE ASSOCIATES PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-29",
        "last_updated": "2023-08-17",
        "certification_date": "2023-08-17",
        "status": "A",
        "authorized_official_last_name": "MILES",
        "authorized_official_first_name": "HENRY",
        "authorized_official_middle_name": "E.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "904-797-5760",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "FL",
            "license": "OPC2080",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in St Augustine, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 17, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.