NPIMap

Organization Active NPI

Promenade Eye Care, LLC

Doing business as Promenade Eye Care

  • Optometrist
  • Coconut Creek, FL
National Provider Identifier
1225457716
Registry record updated Apr 11, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
OPC 4633 Issued in FL
Legal business name
PROMENADE EYE CARE, LLC
Doing business as
Promenade Eye Care
Practice address
4413 Lyons Rd
Suite 101 Doctors of Optometry Next to Lenscrafters
Coconut Creek, FL 33073-4383
Phone
(954) 975-9181
Fax
(954) 975-9597
NPI assigned
Apr 11, 2014
Last updated
Apr 11, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 11, 2014

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

Authorized official

Name
Dr. Anisa KristollariNPI 1760762769
Title
Optometrist
Phone
(954) 975-9181

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 OPC 4633 FL Primary

Addresses

Primary practice location

4413 Lyons Rd
Suite 101 Doctors of Optometry Next to Lenscrafters
Coconut Creek, FL 33073-4383

Mailing address

4413 Lyons Rd
Suite 101 Doctors of Optometry Next to Lenscrafters
Coconut Creek, FL 33073-4383
Phone (954) 975-9181

Other names 1

  • Promenade Eye Care Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20250512000349 FL Part B Supplier - Clinic/Group Practice 0143747329 Receives reassigned benefits from 3 practitioners
Practice locations: Coconut Creek, FL

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 3

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": "1397174400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1397174400000",
    "number": "1225457716",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4413 LYONS RD",
            "address_2": "SUITE 101 DOCTORS OF OPTOMETRY NEXT TO LENSCRAFTERS",
            "city": "COCONUT CREEK",
            "state": "FL",
            "postal_code": "330734383",
            "telephone_number": "954-975-9181",
            "fax_number": "954-975-9597"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4413 LYONS RD",
            "address_2": "SUITE 101 DOCTORS OF OPTOMETRY NEXT TO LENSCRAFTERS",
            "city": "COCONUT CREEK",
            "state": "FL",
            "postal_code": "330734383",
            "telephone_number": "954-975-9181",
            "fax_number": "954-975-9597"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROMENADE EYE CARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-04-11",
        "last_updated": "2014-04-11",
        "status": "A",
        "authorized_official_last_name": "KRISTOLLARI",
        "authorized_official_first_name": "ANISA",
        "authorized_official_title_or_position": "OPTOMETRIST",
        "authorized_official_telephone_number": "954-975-9181",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "FL",
            "license": "OPC 4633",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Promenade Eye Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Coconut Creek, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 11, 2014; 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.