Active NPI
M. F. Diffendall OD PA
- Optometrist
- Phoenix, MD
National Provider Identifier
1194074476
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- TA1372
- Legal business name
- M. F. DIFFENDALL OD PA
- Practice address
- 3332 Paper Mill Rd
Phoenix, MD 21131-1419 - Phone
- (410) 628-1510
- NPI assigned
- Sep 2, 2012
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Michael F Diffendall, OD
- Title
- Owner
- Phone
- (410) 628-1510
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) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | TA1372 | MD | Primary |
Addresses
Primary practice location
3332 Paper Mill Rd
Phoenix, MD 21131-1419
Mailing address
3332 Paper Mill Rd
Phoenix, MD 21131-1419
Phone (410) 628-1510
Other names 1
- Jacksonville Eye Care
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MD
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20130314000104 | MD | Part B Supplier - Clinic/Group Practice | 9335384643 |
Receives reassigned benefits from 2 practitioners Practice locations: Phoenix, MD |
National Provider Directory
National Provider Directory- Tax ID family
- Jacksonville Eye Care
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
-
- Optometrist
- Phoenix, MD
- NPI 1346678240
Locations
3332 Paper Mill Rd
Phoenix, MD 21131
Phone (410) 628-1510
Practitioners & affiliated clinicians
Practitioners 3
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Optometrist
- Phoenix, MD
- NPI 1023099223
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1346544000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1384387200000",
"number": "1194074476",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3332 PAPER MILL RD",
"city": "PHOENIX",
"state": "MD",
"postal_code": "211311419",
"telephone_number": "410-628-1510"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3332 PAPER MILL RD",
"city": "PHOENIX",
"state": "MD",
"postal_code": "211311419",
"telephone_number": "410-628-1510"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "M. F. DIFFENDALL OD PA",
"organizational_subpart": "NO",
"enumeration_date": "2012-09-02",
"last_updated": "2013-11-14",
"status": "A",
"authorized_official_last_name": "DIFFENDALL",
"authorized_official_first_name": "MICHAEL",
"authorized_official_middle_name": "F",
"authorized_official_title_or_position": "OWNER",
"authorized_official_telephone_number": "410-628-1510",
"authorized_official_credential": "OD"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Optometrist",
"state": "MD",
"license": "TA1372",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "Jacksonville Eye Care",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Phoenix, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 14, 2013; 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.