Optometrica O D P a

Primary specialty

OptometristTaxonomy code 152W00000X

License

OPC3502 Issued in 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

Last updated

Oct 1, 2012By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Phong Michael Pham, ODNPI 1588790828

Title

President / Owner

Phone

(239) 560-6917

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Locations

Practitioners 2

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.

• Phong Michael Pham, O.D.

  • Corneal and Contact Management Optometrist
  • Sanibel, FL
  • NPI 1588790828
  Medicare reassignment NPD Authorized official
• Emilio Martinez-Lezama, OD

  • Optometrist
  • Naples, FL
  • NPI 1760464838
  Medicare reassignment NPD

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

{
    "created_epoch": "1343952000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1349049600000",
    "number": "1174879563",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6747 WILLOW LAKE CIR",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339661253",
            "telephone_number": "239-560-6917",
            "fax_number": "239-415-7341"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1571 PERIWINKLE WAY",
            "city": "SANIBEL",
            "state": "FL",
            "postal_code": "339574513",
            "telephone_number": "239-560-6917",
            "fax_number": "239-415-7341"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OPTOMETRICA O D P A",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-08-03",
        "last_updated": "2012-10-01",
        "status": "A",
        "authorized_official_last_name": "PHAM",
        "authorized_official_first_name": "PHONG",
        "authorized_official_middle_name": "MICHAEL",
        "authorized_official_title_or_position": "PRESIDENT / OWNER",
        "authorized_official_telephone_number": "239-560-6917",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "FL",
            "license": "OPC3502",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Millennium Physician Group LLC
• Northland Hearing Centers, Inc (Auditory Associates Hearing Center)
• Nuke Me, PA
• Donald L. Olsen, PT
• Danielle Marie Olson-Basora, MD
• P Denis Kuehner D O P a (San Cap Medical Center)
• Phong Michael Pham, O.D.
• Michael Franz Raab, MD
• Victoria Young Ryan, PHD
• Merritt Sacks, PHARMD

• Optometrist in Sanibel, FL
• Providers in Sanibel, FL by specialty
• Optometrist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.