Individual provider Active NPI

Jenna Rogers, OD

  • Optometrist
  • Orange Park, FL
National Provider Identifier
1114302346
Registry record updated Aug 8, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
OPC5174 Issued in FL
Practice address
28 Blanding Blvd
Orange Park, FL 32073-2202
Phone
(904) 264-5483
Fax
(904) 213-0515
NPI assigned
Jul 29, 2015
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 8, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Vision Therapy Optometrist 152WV0400X OPC5174 FL
Optometrist 152W00000X OPC5174 FL Primary

Addresses

Primary practice location

28 Blanding Blvd
Orange Park, FL 32073-2202

Mailing address

8614 Westwood Center Dr FL 9
Vienna, VA 22182-2442
Phone (703) 847-8899

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
I20161103000548 FL Practitioner - Optometry 8224316757 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
OPC5174FLMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Myeyedr. Optometry of Florida, LLC Optometrist CurrentSince Aug 2, 2021 Accepting new patients
Myeyedr Optometry of Florida, LLC Optometrist CurrentSince Aug 2, 2021 Accepting new patients
Myeyedr Optometry of Florida, LLC Optometrist Current Accepting new patients

Locations

28 Blanding Blvd
Orange Park, FL 32073
Phone (904) 264-5483

1480 Timberlane Rd
Tallahassee, FL 32312
Phone (850) 878-1601

8614 Westwood Center Dr
Fl 9
Vienna, VA 22182

1950 Old Gallows Rd
Ste 520
Vienna, VA 22182

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1438128000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1723075200000",
    "number": "1114302346",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8614 WESTWOOD CENTER DR FL 9",
            "city": "VIENNA",
            "state": "VA",
            "postal_code": "221822442",
            "telephone_number": "703-847-8899",
            "fax_number": "571-223-6780"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "28 BLANDING BLVD",
            "city": "ORANGE PARK",
            "state": "FL",
            "postal_code": "320732202",
            "telephone_number": "904-264-5483",
            "fax_number": "904-213-0515"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROGERS",
        "first_name": "JENNA",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-07-29",
        "last_updated": "2024-08-08",
        "certification_date": "2024-08-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152WV0400X",
            "taxonomy_group": "",
            "desc": "Optometrist, Vision Therapy",
            "state": "FL",
            "license": "OPC5174",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "FL",
            "license": "OPC5174",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Orange Park, FL

Sources for this page

Verify at the official NPI Registry.