Organization Active NPI

Eye Care of South West Florida LLC

  • Optometrist
  • Naples, FL
National Provider Identifier
1215348123
Registry record updated Jun 26, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
OPC3905 Issued in FL
Legal business name
EYE CARE OF SOUTH WEST FLORIDA LLC
Practice address
2382 Immokalee Rd
Naples, FL 34110-1446
Phone
(239) 631-6451
Fax
(239) 631-6455
NPI assigned
May 13, 2014
Last updated
Jun 26, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 26, 2020

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

Authorized official

Name
Dr. Jill Sagona, ODNPI 1023126091
Title
Optometrist
Phone
(239) 631-6451

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
Optometrist 152W00000X OPC3905 FL Primary

Addresses

Primary practice location

2382 Immokalee Rd
Naples, FL 34110-1446

Mailing address

2382 Immokalee Rd
Naples, FL 34110-1446
Phone (239) 631-6451

Other identifiers 1

IdentifierTypeStateIssuer
011934900MedicaidFL

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20140806002495 FL Part B Supplier - Clinic/Group Practice 8921225434 Receives reassigned benefits from 1 practitioner
Practice locations: Naples, FL

National Provider Directory

National Provider Directory

Locations

2382 Immokalee Rd
Naples, FL 34110
Phone (239) 631-6451

Practitioners & affiliated clinicians

Practitioners 1

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": "1399939200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1593129600000",
    "number": "1215348123",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2382 IMMOKALEE RD",
            "city": "NAPLES",
            "state": "FL",
            "postal_code": "341101446",
            "telephone_number": "239-631-6451",
            "fax_number": "239-631-6455"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2382 IMMOKALEE RD",
            "city": "NAPLES",
            "state": "FL",
            "postal_code": "341101446",
            "telephone_number": "239-631-6451",
            "fax_number": "239-631-6455"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EYE CARE OF SOUTH WEST FLORIDA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-05-13",
        "last_updated": "2020-06-26",
        "certification_date": "2020-06-26",
        "status": "A",
        "authorized_official_last_name": "SAGONA",
        "authorized_official_first_name": "JILL",
        "authorized_official_title_or_position": "OPTOMETRIST",
        "authorized_official_telephone_number": "239-631-6451",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "FL",
            "license": "OPC3905",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "011934900",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Naples, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 26, 2020; 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.