NPIMap

Organization Active NPI

Emerald Coast Eye Institute, LLC

  • Durable Medical Equipment & Medical Supplies
  • Fort Walton Beach, FL
National Provider Identifier
1164638680
Registry record updated Nov 6, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X
Legal business name
EMERALD COAST EYE INSTITUTE, LLC
Practice address
911 Mar Walt Dr
Fort Walton Beach, FL 32547-6705
Phone
(850) 862-4001
Fax
(850) 862-1612
NPI assigned
May 14, 2007
Last updated
Nov 6, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 6, 2023

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

Authorized official

Name
Noreen Poppell
Title
Administrator
Phone
(850) 862-4001

Specialties & licenses 1

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

Addresses

Primary practice location

911 Mar Walt Dr
Fort Walton Beach, FL 32547-6705

Mailing address

911 Mar Walt Dr
Fort Walton Beach, FL 32547-6705
Phone (850) 862-4001

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100930030638 FL DME Supplier - Physician - OphthalmologyDME Supplier - Physician - OptometristDME Supplier - Optician 7517862329 Practice locations: Fort Walton Beach, FL

Other NPIs with the same Medicare PAC ID 1

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
Emerald Coast Eye Institute LLC911 Mar Walt Dr, Fort Walton Beach, FL 32547-6705(850) 862-4001 Prosthetic Lenses: Conventional Eyeglasses|Prosthetic Lenses: Conventional Contact Lenses Accepts assignmentParticipating since Jan 1, 2002

National Provider Directory

National Provider Directory
Tax ID family
Emerald Coast Eye Institute2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Locations

120 E Redstone Ave
Ste B
Crestview, FL 32539
Phone (850) 398-8600

911 Mar Walt Dr
Ft Walton Bch, FL 32547
Phone (850) 862-4001

Interoperability endpoints

  • FHIR API: https://app.meldrx.com/api/fhir/ec21ei41

Practitioners & affiliated clinicians

Practitioners 14

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.

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1179100800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1699228800000",
    "number": "1164638680",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "911 MAR WALT DR",
            "city": "FORT WALTON BEACH",
            "state": "FL",
            "postal_code": "325476705",
            "telephone_number": "850-862-4001",
            "fax_number": "850-862-1612"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "911 MAR WALT DR",
            "city": "FORT WALTON BEACH",
            "state": "FL",
            "postal_code": "325476705",
            "telephone_number": "850-862-4001",
            "fax_number": "850-862-1612"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EMERALD COAST EYE INSTITUTE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-14",
        "last_updated": "2023-11-06",
        "certification_date": "2023-11-06",
        "status": "A",
        "authorized_official_last_name": "POPPELL",
        "authorized_official_first_name": "NOREEN",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "850-862-4001"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Walton Beach, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 6, 2023; 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.