NPIMap

Organization Active NPI

Provision Laser Eye Center PA

  • Ophthalmology Physician
  • Venice, FL
National Provider Identifier
1184616146
Registry record updated Dec 21, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
Legal business name
PROVISION LASER EYE CENTER PA
Practice address
1191 Jacaranda Blvd
Venice, FL 34292-4518
Phone
(941) 493-0311
Fax
(941) 492-4655
NPI assigned
Aug 16, 2005
Last updated
Dec 21, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 21, 2011

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

Authorized official

Name
Scott P Durrett, MDNPI 1558366898
Title
Owner
Phone
(941) 493-0311

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ophthalmology Physician 207W00000X Primary

Addresses

Primary practice location

1191 Jacaranda Blvd
Venice, FL 34292-4518

Mailing address

1191 Jacaranda Blvd
Venice, FL 34292-4518
Phone (941) 493-0311

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040806000990 FL Part B Supplier - Clinic/Group Practice 1254303670 Receives reassigned benefits from 2 practitioners
Practice locations: Venice, FL

National Provider Directory

National Provider Directory

Interoperability endpoints

  • Direct secure messaging: rdaddario@plec.intellechartdirect.net
  • Direct secure messaging: sdurrett@plec.intellechartdirect.net

Practitioners & affiliated clinicians

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.

NPI Registry JSON

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

{
    "created_epoch": "1124150400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1324425600000",
    "number": "1184616146",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1191 JACARANDA BLVD",
            "city": "VENICE",
            "state": "FL",
            "postal_code": "342924518",
            "telephone_number": "941-493-0311",
            "fax_number": "941-492-4655"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1191 JACARANDA BLVD",
            "city": "VENICE",
            "state": "FL",
            "postal_code": "342924518",
            "telephone_number": "941-493-0311",
            "fax_number": "941-492-4655"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVISION LASER EYE CENTER PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-08-16",
        "last_updated": "2011-12-21",
        "status": "A",
        "authorized_official_last_name": "DURRETT",
        "authorized_official_first_name": "SCOTT",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "941-493-0311",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Venice, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 21, 2011; 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.