Organization Active NPI

Susan S Whaley OD LLC

  • Optometrist
  • Tallahassee, FL
National Provider Identifier
1245750058
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
Legal business name
SUSAN S WHALEY OD LLC
Practice address
2858 Mahan Dr Ste 4
Tallahassee, FL 32308-5472
Phone
(850) 216-2020
NPI assigned
Jun 22, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Authorized official

Name
Judi Wilford
Title
Office Manager
Phone
(850) 216-2020

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X Primary

Addresses

Primary practice location

2858 Mahan Dr Ste 4
Tallahassee, FL 32308-5472

Mailing address

2858 Mahan Dr Ste 4
Tallahassee, FL 32308-5472
Phone (850) 216-2020

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20171020001852 FL Part B Supplier - Clinic/Group Practice 0547536468 Receives reassigned benefits from 4 practitioners
Practice locations: Tallahassee, FL

National Provider Directory

National Provider Directory

Locations

2858 Mahan Dr
Ste 4
Tallahassee, FL 32308
Phone (850) 216-2020

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1498089600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1245750058",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2858 MAHAN DR STE 4",
            "city": "TALLAHASSEE",
            "state": "FL",
            "postal_code": "323085472",
            "telephone_number": "850-216-2020"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2858 MAHAN DR STE 4",
            "city": "TALLAHASSEE",
            "state": "FL",
            "postal_code": "323085472",
            "telephone_number": "850-216-2020"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUSAN S WHALEY OD LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-06-22",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "WILFORD",
        "authorized_official_first_name": "JUDI",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "850-216-2020"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tallahassee, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.