Individual provider Active NPI

Levy John Varghese

  • Optometrist
  • Winter Haven, FL
National Provider Identifier
1255999355
Registry record updated Jun 3, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
5649 Issued in FL
Practice address
723 3Rd St SW
Winter Haven, FL 33880-3419
Phone
(863) 297-5067
NPI assigned
Jun 3, 2019
Last updated
Jun 3, 2019By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 3, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 5649 FL Primary

Addresses

Primary practice location

723 3Rd St SW
Winter Haven, FL 33880-3419

Mailing address

3404 Summerwood Way
Lakeland, FL 33812-5019

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190726000039 FL Practitioner - Optometry 6709112840 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Eye Doctors Optical Outlets PAGroup PAC ID 0042123846, 97 clinicians

Practice addresses (Care Compare)

5607 Johns Rd
Tampa, FL 33634-4499
Phone (813) 385-1873

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
5649FLMDHearing Instrument Specialist

Practice roles

OrganizationSpecialtyStatusNew patients
Eye Doctors Optical Outlets PA Optometrist CurrentSince Jun 9, 2019 Accepting new patients
Eye Doctors Optical Outlets PA Optometrist CurrentSince Jun 9, 2019 Accepting new patients
Eye Doctors Optical Outlets PA Optometrist PastSince Apr 6, 2023 Accepting new patients
Eye Doctors Optical Outlets, PA Optometrist Past Accepting new patients

Locations

7 Eagle Ridge Dr
Lake Wales, FL 33859
Phone (863) 676-0911

5607 Johns Rd
Tampa, FL 33634
Phone (813) 385-1873

723 3rd St SW
Winter Haven, FL 33880
Phone (863) 297-5067

Networks

  • Freedom Health HMO Network

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1559520000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1559520000000",
    "number": "1255999355",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3404 SUMMERWOOD WAY",
            "city": "LAKELAND",
            "state": "FL",
            "postal_code": "338125019"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "723 3RD ST SW",
            "city": "WINTER HAVEN",
            "state": "FL",
            "postal_code": "338803419",
            "telephone_number": "863-297-5067"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VARGHESE",
        "first_name": "LEVY",
        "middle_name": "JOHN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-06-03",
        "last_updated": "2019-06-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "FL",
            "license": "5649",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Winter Haven, FL

Sources for this page

Verify at the official NPI Registry.