Fort Pierce Vision LLC

Primary specialty

Health Maintenance OrganizationTaxonomy code 302R00000X

License

OPC2169 Issued in FL

Legal business name

FORT PIERCE VISION LLC

Practice address

5100 Okeechobee Rd
Fort Pierce, FL 34947-5428

Phone

(954) 821-1111

Fax

(772) 336-9017

NPI assigned

Sep 21, 2015

Organization subpart

No

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

Authorized official

Name

Dr. Philip C Desantis, O.D.

Title

Manager

Phone

(954) 821-1111

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1442793600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1442793600000",
    "number": "1144699042",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5100 OKEECHOBEE RD",
            "city": "FORT PIERCE",
            "state": "FL",
            "postal_code": "349475428",
            "telephone_number": "954-821-1111",
            "fax_number": "772-336-9017"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5100 OKEECHOBEE RD",
            "city": "FORT PIERCE",
            "state": "FL",
            "postal_code": "349475428",
            "telephone_number": "954-821-1111",
            "fax_number": "772-336-9017"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FORT PIERCE VISION LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-09-21",
        "last_updated": "2015-09-21",
        "status": "A",
        "authorized_official_last_name": "DESANTIS",
        "authorized_official_first_name": "PHILIP",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "954-821-1111",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "302R00000X",
            "taxonomy_group": "",
            "desc": "Health Maintenance Organization",
            "state": "FL",
            "license": "OPC2169",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "010527400",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Fort Pierce Discount Pharmacy, Inc.
• Fort Pierce Family Care, Inc.
• Fort Pierce Health Care Associates LLC (Fort Pierce Health Care)
• Fort Pierce Intermediate Care Center (Fort Pierce Walk-In Medical Clinic)
• Fort Pierce Orthopaedics LLC
• Tisa D Forte, RN
• Eddrekcia Foster
• Elizabeth Fowler
• Chasity Shanell Fowlkes, LMHC, CAP
• FP Medical

• Health Maintenance Organization in Fort Pierce, FL
• Providers in Fort Pierce, FL by specialty
• Health Maintenance Organization in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 21, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.