NPIMap

Organization Active NPI

St George OD LLC

  • Optometrist
  • Boynton Beach, FL
National Provider Identifier
1174912794
Registry record updated Jan 20, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
OPC4985 Issued in FL
Legal business name
ST GEORGE OD LLC
Practice address
5058 Greenwich Preserve CT
Boynton Beach, FL 33436-5802
Phone
(954) 624-5649
NPI assigned
Jan 20, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 20, 2015

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

Authorized official

Name
Dr. Reta Guirguis, O.D.
Title
Optometrist
Phone
(954) 624-5649

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X OPC4985 FL Primary

Addresses

Primary practice location

5058 Greenwich Preserve CT
Boynton Beach, FL 33436-5802

Mailing address

5058 Greenwich Preserve CT
Boynton Beach, FL 33436-5802
Phone (954) 624-5649

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1421712000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1421712000000",
    "number": "1174912794",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5058 GREENWICH PRESERVE CT",
            "city": "BOYNTON BEACH",
            "state": "FL",
            "postal_code": "334365802",
            "telephone_number": "954-624-5649"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5058 GREENWICH PRESERVE CT",
            "city": "BOYNTON BEACH",
            "state": "FL",
            "postal_code": "334365802",
            "telephone_number": "954-624-5649"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST GEORGE OD LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-01-20",
        "last_updated": "2015-01-20",
        "status": "A",
        "authorized_official_last_name": "GUIRGUIS",
        "authorized_official_first_name": "RETA",
        "authorized_official_title_or_position": "OPTOMETRIST",
        "authorized_official_telephone_number": "954-624-5649",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "FL",
            "license": "OPC4985",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Boynton Beach, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 20, 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.