NPIMap

Organization Active NPI

Ecsa Optical Company, LLC

  • Durable Medical Equipment & Medical Supplies
  • Palm Coast, FL
National Provider Identifier
1114779030
Registry record updated Apr 3, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X
Legal business name
ECSA OPTICAL COMPANY, LLC
Practice address
10 Florida Park Dr Ste a
Palm Coast, FL 32137-3893
Phone
(386) 445-1279
Fax
(904) 810-5687
NPI assigned
Apr 3, 2024
Last updated
Apr 3, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 3, 2024

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

Authorized official

Name
Candice B Davis
Title
Chief Revenue Cycle Officer
Phone
(916) 990-7590

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X Primary

Addresses

Primary practice location

10 Florida Park Dr Ste a
Palm Coast, FL 32137-3893

Mailing address

10 Florida Park Dr Ste a
Palm Coast, FL 32137-3893
Phone (386) 445-1279

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20250401001201 FL DME Supplier - Physician - OphthalmologyDME Supplier - Physician - Optometrist 5698978963 Practice locations: Palm Coast, FL

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

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
Ecsa Optical Company LLC10 Florida Park Dr, Palm Coast, FL 32137-3893(386) 445-1279 Prosthetic Lenses: Conventional Eyeglasses|Prosthetic Lenses: Conventional Contact Lenses Accepts assignmentParticipating since Mar 26, 2025

National Provider Directory

National Provider Directory
Tax ID family
Ecsa Optical Company LLC4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

10 Florida Park Dr N
Ste A
Palm Coast, FL 32137
Phone (386) 445-1279

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1712102400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1712102400000",
    "number": "1114779030",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10 FLORIDA PARK DR STE A",
            "city": "PALM COAST",
            "state": "FL",
            "postal_code": "321373893",
            "telephone_number": "386-445-1279",
            "fax_number": "904-810-5687"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10 FLORIDA PARK DR STE A",
            "city": "PALM COAST",
            "state": "FL",
            "postal_code": "321373893",
            "telephone_number": "386-445-1279",
            "fax_number": "904-810-5687"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ECSA OPTICAL COMPANY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-04-03",
        "last_updated": "2024-04-03",
        "certification_date": "2024-04-03",
        "status": "A",
        "authorized_official_last_name": "DAVIS",
        "authorized_official_first_name": "CANDICE",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "CHIEF REVENUE CYCLE OFFICER",
        "authorized_official_telephone_number": "916-990-7590"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Palm Coast, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 3, 2024; 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.