Active NPI
Cabana Eyes Optical
- Eyewear Supplier
- Crestview, FL
National Provider Identifier
1154867554
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Eyewear Supplier
- Legal business name
- CABANA EYES OPTICAL
- Practice address
- 4100 S Ferdon Blvd
Suite B5
Crestview, FL 32536-5252 - Phone
- (850) 758-0474
- Fax
- (850) 826-0057
- NPI assigned
- Jan 10, 2017
- Organization subpart
- Yes
- Parent organization
- EDWARD MITCHELL JR
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mr. Edward Mitchell Jr., LDO
- Title
- Owner/ Visual Resource Director
- Phone
- (850) 758-0474
Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Specialty Clinic/Center | 261QM2500X | |||
| Eyewear Supplier | 332H00000X | Primary |
Addresses
Primary practice location
4100 S Ferdon Blvd
Suite B5
Crestview, FL 32536-5252
Mailing address
4100 S Ferdon Blvd
Suite B5
Crestview, FL 32536-5252
Phone (850) 306-2580
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 003088900 | Medicaid | FL |
National Provider Directory
National Provider Directory- Part of
- Cabana Eyes Optical
Locations
4100 S Ferdon Blvd
Ste B5
Crestview, FL 32536
Phone (850) 682-3628
Practitioners & affiliated clinicians
Practitioners 1
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Eyewear Supplier
- Crestview, FL
- NPI 1811139462
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1484006400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1571788800000",
"number": "1154867554",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4100 S FERDON BLVD",
"address_2": "SUITE B5",
"city": "CRESTVIEW",
"state": "FL",
"postal_code": "325365252",
"telephone_number": "850-306-2580",
"fax_number": "850-423-0142"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4100 S FERDON BLVD",
"address_2": "SUITE B5",
"city": "CRESTVIEW",
"state": "FL",
"postal_code": "325365252",
"telephone_number": "850-758-0474",
"fax_number": "850-826-0057"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "CABANA EYES OPTICAL",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "EDWARD MITCHELL JR",
"enumeration_date": "2017-01-10",
"last_updated": "2019-10-23",
"status": "A",
"authorized_official_last_name": "MITCHELL",
"authorized_official_first_name": "EDWARD",
"authorized_official_title_or_position": "OWNER/ VISUAL RESOURCE DIRECTOR",
"authorized_official_telephone_number": "850-758-0474",
"authorized_official_name_prefix": "Mr.",
"authorized_official_name_suffix": "Jr.",
"authorized_official_credential": "LDO"
},
"taxonomies": [
{
"code": "261QM2500X",
"taxonomy_group": "",
"desc": "Clinic/Center, Medical Specialty",
"state": null,
"license": null,
"primary": false
},
{
"code": "332H00000X",
"taxonomy_group": "",
"desc": "Eyewear Supplier",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "003088900",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Crestview, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 23, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.