Mitchell Robert Petit, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

OPC 3419 Issued in FL

Practice address

2000 66TH St N
St Petersburg, FL 33710-4710

Phone

(727) 341-1987

Fax

(727) 347-7297

NPI assigned

Jun 13, 2005

Last updated

Feb 4, 2016By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 9

Medicare fee-for-service enrollment

Enrolled in FL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Optometry

Education

Other, 1993

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Southeast Eye Institute PAGroup PAC ID 8224931993, 31 clinicians

Antonio Prado MD PAGroup PAC ID 3072612506, 9 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Networks

• Freedom Health HMO Network

Interoperability endpoints

• Direct secure messaging: mpetit@eapinellas.intellechartdirect.net
• Direct secure messaging: mpetit@pradovision.intellechartdirect.net

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Antonio Prado MD PA

  dba Prado Vision Center

  • Optometrist
  • Tampa, FL
  • NPI 1376675454
  Medicare reassignment Care Compare group NPD
• Southeast Eye Institute, PA

  dba Eye Associates of Pinellas

  • Ophthalmology Physician
  • Pinellas Park, FL
  • NPI 1073625331

  Optometrist

  Medicare reassignment Care Compare group NPD
• Gulf Coast Optometry, PA

  • Corneal and Contact Management Optometrist
  • Tampa, FL
  • NPI 1083859409
  Medicare reassignment NPD
• Medical Eye Associates of Tampa,P.a.

  • Ophthalmology Physician
  • Tampa, FL
  • NPI 1669743837
  NPD (past)
• National Vision, Inc.

  dba EyeGlass World

  • Eyewear Supplier
  • Altamonte Springs, FL
  • NPI 1023164886
  NPD (past)
• National Vision, Inc.

  dba EyeGlass World

  • Eyewear Supplier
  • Fort Meyers, FL
  • NPI 1477607521
  NPD (past)
• Vision Specialty Associates, P.a.

  dba Vision Specialty Assoc. P.a. #01

  • Optometrist
  • Ruskin, FL
  • NPI 1003021411
  NPD (past)

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

{
    "created_epoch": "1118620800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1454544000000",
    "number": "1184628547",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3115 W SWANN AVE",
            "address_2": "STE 200",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336094617",
            "telephone_number": "813-908-2020",
            "fax_number": "813-908-2133"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2000 66TH ST N",
            "city": "ST PETERSBURG",
            "state": "FL",
            "postal_code": "337104710",
            "telephone_number": "727-341-1987",
            "fax_number": "727-347-7297"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETIT",
        "first_name": "MITCHELL",
        "middle_name": "ROBERT",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-13",
        "last_updated": "2016-02-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "FL",
            "license": "OPC 3419",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLARITY VISION PLAN",
            "identifier": "261355",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ALLIED EYECARE",
            "identifier": "593651926",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SPECTERA",
            "identifier": "11436",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NVA",
            "identifier": "487101",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ECPA",
            "identifier": "3419",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "COLE VISION PLAN",
            "identifier": "261355",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HUMANA",
            "identifier": "410001004",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AVESIS",
            "identifier": "VFL000856",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "620670100",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Christopher Peterson
• Daniel Peterson
• Felipe Peterson, DPM
• John A. Peterson, MD
• Larnetta Renne Peterson
• Thomas E Petit, LMHC
• Lisa E Petitfils, M.D.
• Guy Timothy Petito, O.D.
• Renee Petrie
• Vincent R Petronelli, APRN

• Optometrist in St Petersburg, FL
• Providers in St Petersburg, FL by specialty
• Optometrist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 4, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.