Individual provider Active NPI

Todd Alan Shettle, O.D.

  • Optometrist
  • Largo, FL
National Provider Identifier
1194725663
Registry record updated Feb 23, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
OPC3278 Issued in FL
Practice address
670 Clearwater Largo Rd N
Suite B
Largo, FL 33770-2377
Phone
(727) 586-1260
Fax
(727) 586-3636
NPI assigned
Jul 27, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 23, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X OPC3278 FL Primary

Addresses

Primary practice location

670 Clearwater Largo Rd N
Suite B
Largo, FL 33770-2377

Mailing address

670 Clearwater Largo Rd N
Suite B
Largo, FL 33770-2377
Phone (727) 586-1260

Other identifiers 1

IdentifierTypeStateIssuer
620433300MedicaidFL

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20040330000207 FL Practitioner - Optometry 6709778061 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Other, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

670 Clearwater Largo Rd N
Suite a
Largo, FL 33770-2377
Phone (727) 586-1260

Procedures performed for Medicare patients

ProcedureNumber of procedures
Cataract surgery1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Shettle Optical Solutions,Inc. Optometrist CurrentSince Apr 26, 2009 Accepting new patients
TB Eye Care PA Optometrist Past Accepting new patients
Philip L. Shettle D.O., P.a. PastSince Apr 26, 2009 Accepting new patients
Optometric Associates of Florida, P.a. Optometrist Past Accepting new patients

Locations

670 Clearwater Largo Rd N
Ste B
Largo, FL 33770
Phone (256) 503-3370

670 Clearwater Largo Rd N
Largo, FL 33770
Phone (727) 581-8755

670 Clearwater Largo Rd N
Ste A
Largo, FL 33770
Phone (727) 581-8755

Organizations & group practices 4

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

NPI Registry JSON

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

{
    "created_epoch": "1122422400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1329955200000",
    "number": "1194725663",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "670 CLEARWATER LARGO RD N",
            "address_2": "SUITE B",
            "city": "LARGO",
            "state": "FL",
            "postal_code": "337702377",
            "telephone_number": "727-586-1260",
            "fax_number": "727-586-3636"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "670 CLEARWATER LARGO RD N",
            "address_2": "SUITE B",
            "city": "LARGO",
            "state": "FL",
            "postal_code": "337702377",
            "telephone_number": "727-586-1260",
            "fax_number": "727-586-3636"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHETTLE",
        "first_name": "TODD",
        "middle_name": "ALAN",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-07-27",
        "last_updated": "2012-02-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "FL",
            "license": "OPC3278",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "620433300",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Largo, FL

Sources for this page

Verify at the official NPI Registry.