Individual provider Active NPI

Stephanie Rosa Negron

  • Optometrist
  • Jacksonville, FL
National Provider Identifier
1124590500
Registry record updated Dec 22, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
5618 Issued in FL
Practice address
13221 City Station Dr Ste 153
Jacksonville, FL 32218-7251
Phone
(904) 696-8887
NPI assigned
Dec 22, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 22, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 5618 FL Primary

Addresses

Primary practice location

13221 City Station Dr Ste 153
Jacksonville, FL 32218-7251

Mailing address

13221 City Station Dr Ste 153
Jacksonville, FL 32218-7251
Phone (904) 696-8887

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
I20200908000636 FL Practitioner - Optometry 1052738044 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
5618FLMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Gulf Coast Optometry, PA CurrentSince Aug 1, 2020 Accepting new patients
Island Eyecare PA Optometrist CurrentSince Sep 2, 2020 Accepting new patients
National Vision, Inc. Past Accepting new patients
National Vision, Inc. Past Accepting new patients
America'S Best Contacts & Eyeglasses Past Accepting new patients

Locations

706 W State Road 436
Altamonte Springs, FL 32714
Phone (407) 774-1318

4957 S Cleveland Ave
Fort Myers, FL 33907
Phone (239) 278-1217

13534 Beach Blvd
#3
Jacksonville, FL 32224
Phone (904) 383-3400

2411 SW College Rd
Ocala, FL 34471
Phone (352) 873-3937

901 Blanding Blvd
Ste 4
Orange Park, FL 32065
Phone (904) 562-1160

1725 W Mlk Blvd
Tampa, FL 33607
Phone (239) 800-1717

Organizations & group practices 5

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": "1545436800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1545436800000",
    "number": "1124590500",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13221 CITY STATION DR STE 153",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322187251",
            "telephone_number": "904-696-8887"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13221 CITY STATION DR STE 153",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322187251",
            "telephone_number": "904-696-8887"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NEGRON",
        "first_name": "STEPHANIE",
        "middle_name": "ROSA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-12-22",
        "last_updated": "2018-12-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "FL",
            "license": "5618",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jacksonville, FL

Sources for this page

Verify at the official NPI Registry.