NPIMap

Organization Active NPI

Low Vision Center of Northeast Florida Inc

  • Optometrist
  • Jacksonville, FL
National Provider Identifier
1235329848
Registry record updated Jun 25, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
OPC4045 Issued in FL
Legal business name
LOW VISION CENTER OF NORTHEAST FLORIDA INC
Practice address
2519 Riverside Avenue
Jacksonville, FL 32204-4710
Phone
(904) 389-9989
Fax
(904) 389-1060
NPI assigned
Jul 30, 2007
Last updated
Jun 25, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 25, 2008

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

Authorized official

Name
Dr. Tiffany E Owens, OD
Title
Clinical Director
Phone
(904) 389-9989

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X OPC4045 FL Primary

Addresses

Primary practice location

2519 Riverside Avenue
Jacksonville, FL 32204-4710

Mailing address

2519 Riverside Avenue
Jacksonville, FL 32204-4710
Phone (904) 389-9989

Other identifiers 3

IdentifierTypeStateIssuer
621075900MedicaidFL
28569OtherFLBCBS
DE3862OtherRAILROAD MEDICARE

National Provider Directory

National Provider Directory

Locations

2519 Riverside Ave
Jacksonville, FL 32204
Phone (904) 389-9989

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": "1185753600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1214352000000",
    "number": "1235329848",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2519 RIVERSIDE AVENUE",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322044710",
            "telephone_number": "904-389-9989",
            "fax_number": "904-389-1060"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2519 RIVERSIDE AVENUE",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322044710",
            "telephone_number": "904-389-9989",
            "fax_number": "904-389-1060"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LOW VISION CENTER OF NORTHEAST FLORIDA INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-07-30",
        "last_updated": "2008-06-25",
        "status": "A",
        "authorized_official_last_name": "OWENS",
        "authorized_official_first_name": "TIFFANY",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "CLINICAL DIRECTOR",
        "authorized_official_telephone_number": "904-389-9989",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "FL",
            "license": "OPC4045",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "621075900",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "28569",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "DE3862",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Jacksonville, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.