Individual provider Active NPI

Gayle P Leinwohl, OD

  • Optometrist
  • Jacksonville, FL
National Provider Identifier
1194743500
Registry record updated Nov 4, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
OPC 2993 Issued in FL
Practice address
9397 San Jose Blvd
Suite 2
Jacksonville, FL 32257-5587
Phone
(904) 730-2299
Fax
(904) 730-2557
NPI assigned
Jul 17, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 4, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X OPC 2993 FL Primary

Addresses

Primary practice location

9397 San Jose Blvd
Suite 2
Jacksonville, FL 32257-5587

Mailing address

9397 San Jose Blvd
Suite 2
Jacksonville, FL 32257-5587
Phone (904) 730-2299

Other identifiers 1

IdentifierTypeStateIssuer
620245401MedicaidFL

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
I20111116000485 FL Practitioner - Optometry 4981878568 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
State University of New York - State College Optometry, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

9397 San Jose Blvd
Suite 2
Jacksonville, FL 32257-5587
Phone (904) 730-2299

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
OPC 2993FLMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Val-U-Vision of Beauclerc-Mandarin Inc Optometrist CurrentSince Dec 11, 2012 Accepting new patients
Val-U-Vision Inc Optometrist PastSince Jan 1, 2000 Accepting new patients
Optometric Associates of Florida, P.a. Optometrist Past Accepting new patients

Locations

9397 San Jose Blvd
Unit 2
Jacksonville, FL 32257
Phone (904) 730-2299

Organizations & group practices 3

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": "1153094400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1446595200000",
    "number": "1194743500",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9397 SAN JOSE BLVD",
            "address_2": "SUITE 2",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322575587",
            "telephone_number": "904-730-2299",
            "fax_number": "904-730-2557"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9397 SAN JOSE BLVD",
            "address_2": "SUITE 2",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322575587",
            "telephone_number": "904-730-2299",
            "fax_number": "904-730-2557"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LEINWOHL",
        "first_name": "GAYLE",
        "middle_name": "P",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-17",
        "last_updated": "2015-11-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "FL",
            "license": "OPC 2993",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "620245401",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Jacksonville, FL

Sources for this page

Verify at the official NPI Registry.