Optometrica O D P a
Organization Active NPI Optometrist · Sanibel, FL
NPI 1174879563 · NPPES record last updated Oct 1, 2012
Key facts
- NPI
- 1174879563
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Optometrist 152W00000X
- License
- OPC3502 (FL)
- Legal business name
- OPTOMETRICA O D P A
- Practice address
- 1571 Periwinkle Way
Sanibel, FL 33957-4513 - Phone
- (239) 560-6917
- Fax
- (239) 415-7341
- NPI assigned
- Aug 3, 2012
- Organization subpart
- No
Authorized official
- Name
- Dr. Phong Michael Pham, OD
- Title
- President / Owner
- Phone
- (239) 560-6917
Practitioners 2
-
Phong Michael Pham, O.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in FL
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20120831000454 | FL | Part B Supplier - Clinic/Group Practice | 9638326325 |
Receives reassigned benefits from 2 practitioners Practice locations: Sanibel, FL |
National Provider Directory
Locations
16876 McGregor Blvd
Ste 102
Fort Myers, FL 33908
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist |
152W00000X | OPC3502 | FL | Yes |
Addresses
Primary practice location
1571 Periwinkle Way
Sanibel, FL 33957-4513
Mailing address
6747 Willow Lake Cir
Fort Myers, FL 33966-1253
Phone (239) 560-6917
Other providers in Sanibel, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 1, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.