Individual provider Active NPI

Crystal Varela, OD

  • Optometrist
  • Davie, FL
National Provider Identifier
1114650538
Registry record updated Jul 4, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
129121629934 Issued in UT
Practice address
3200 S University Dr BLDG 1402
Davie, FL 33328-2018
Phone
(954) 262-4335
Fax
(954) 262-3904
NPI assigned
Jul 4, 2022
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 4, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 129121629934 UT Primary

Addresses

Primary practice location

3200 S University Dr BLDG 1402
Davie, FL 33328-2018

Mailing address

PO Box 290370
Davie, FL 33329-0370
Phone (954) 262-4397

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
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
I20240820000849 TX Practitioner - Optometry 2769851708 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
10686TXMDOrthodontics and Dentofacial Orthopedic Dentist
129121629934UTMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Modern Optometry PLLC Optometrist CurrentSince Feb 16, 2025 Accepting new patients
Nova Southeastern University, Inc Past Accepting new patients

Locations

6301 NW Loop 410
Ste 21A
San Antonio, TX 78238
Phone (210) 680-6097

5535 W Loop 1604 N
Ste 104
San Antonio, TX 78253
Phone (210) 415-4230

7400 San Pedro Ave
Ste 486A
San Antonio, TX 78216
Phone (210) 541-0008

6301 NW Loop 410
San Antonio, TX 78238
Phone (210) 523-4068

15900 La Cantera Pkwy
Ste 6697
San Antonio, TX 78256
Phone (210) 694-4110

Organizations & group practices 2

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": "1656892800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1656892800000",
    "number": "1114650538",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 290370",
            "city": "DAVIE",
            "state": "FL",
            "postal_code": "333290370",
            "telephone_number": "954-262-4397",
            "fax_number": "954-262-2269"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3200 S UNIVERSITY DR BLDG 1402",
            "city": "DAVIE",
            "state": "FL",
            "postal_code": "333282018",
            "telephone_number": "954-262-4335",
            "fax_number": "954-262-3904"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VARELA",
        "first_name": "CRYSTAL",
        "credential": "OD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-07-04",
        "last_updated": "2022-07-04",
        "certification_date": "2022-07-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "UT",
            "license": "129121629934",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Davie, FL

Sources for this page

Verify at the official NPI Registry.