Individual provider Active NPI

Hajira M Shujaat, O.D.

  • Optometrist
  • Ocoee, FL
National Provider Identifier
1255398707
Registry record updated Jan 26, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
OPC 4096 Issued in FL
Practice address
10000 West Colonial Dr.
Suite 183
Ocoee, FL 34761-3434
Phone
(407) 834-7776
Fax
(407) 834-0973
NPI assigned
Apr 27, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 26, 2011

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 4096 FL Primary

Addresses

Primary practice location

10000 West Colonial Dr.
Suite 183
Ocoee, FL 34761-3434

Mailing address

160 Boston Ave
Altamonte Springs, FL 32701-4798
Phone (407) 834-7776

Other identifiers 1

IdentifierTypeStateIssuer
621123200MedicaidFL

Other names 1

  • Hajira Moinuddin Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
OPC 4096FLMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Florida Eye Clinic P a Optometrist Past Accepting new patients
Florida Eye Clinic PA Optometrist Past Accepting new patients

Organizations & group practices 2

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": "1146096000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1296000000000",
    "number": "1255398707",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "160 BOSTON AVE",
            "city": "ALTAMONTE SPRINGS",
            "state": "FL",
            "postal_code": "327014798",
            "telephone_number": "407-834-7776",
            "fax_number": "407-834-0973"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10000 WEST COLONIAL DR.",
            "address_2": "SUITE 183",
            "city": "OCOEE",
            "state": "FL",
            "postal_code": "347613434",
            "telephone_number": "407-834-7776",
            "fax_number": "407-834-0973"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHUJAAT",
        "first_name": "HAJIRA",
        "middle_name": "M",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-04-27",
        "last_updated": "2011-01-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "FL",
            "license": "OPC 4096",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "621123200",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "HAJIRA",
            "last_name": "MOINUDDIN",
            "credential": "O.D.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Ocoee, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 26, 2011; 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.