Florida Vision Optique, Inc

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

License

OPC2170 Issued in FL

Legal business name

FLORIDA VISION OPTIQUE, INC

Practice address

10050 SW Innovation Way Ste 101
Port Saint Lucie, FL 34987-2117

Phone

(772) 345-5050

Fax

(772) 223-7159

NPI assigned

Feb 4, 2014

Organization subpart

No

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

Authorized official

Name

George L Neal

Title

President

Phone

(469) 214-0144

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

• Florida Vision Optique Inc

  • Optometrist
  • Stuart, FL
  • NPI 1023018355

  4183839277

  Same PAC ID

Tax ID family

Florida Vision Optique Inc3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

• Florida Vision Optique Inc

  • Optometrist
  • Stuart, FL
  • NPI 1023018355
  NPD tax ID
• Florida Vision Optique, Inc.

  • Durable Medical Equipment & Medical Supplies
  • Stuart, FL
  • NPI 1912875931
  NPD tax ID

Locations

Practitioners 4

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

• Giovana M Balasquide, O.D.

  • Optometrist
  • Stuart, FL
  • NPI 1033568084
  NPD
• Rafael Angel Diaz, O.D.

  • Optometrist
  • Stuart, FL
  • NPI 1720087737
  NPD
• Michael J Goldberg, O.D.

  • Optometrist
  • Stuart, FL
  • NPI 1205843760
  NPD
• Jack Steven Daubert, MD

  • Ophthalmology Physician
  • Stuart, FL
  • NPI 1790784270
  NPD (past)

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

{
    "created_epoch": "1391472000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1669766400000",
    "number": "1265856702",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1050 SE MONTEREY RD STE 104",
            "city": "STUART",
            "state": "FL",
            "postal_code": "349944512",
            "telephone_number": "772-345-5050",
            "fax_number": "772-223-7159"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10050 SW INNOVATION WAY STE 101",
            "city": "PORT SAINT LUCIE",
            "state": "FL",
            "postal_code": "349872117",
            "telephone_number": "772-345-5050",
            "fax_number": "772-223-7159"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FLORIDA VISION OPTIQUE, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-02-04",
        "last_updated": "2022-11-30",
        "certification_date": "2022-11-30",
        "status": "A",
        "authorized_official_last_name": "NEAL",
        "authorized_official_first_name": "GEORGE",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "469-214-0144"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "FL",
            "license": "OPC2170",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FLORIDA BLUE",
            "identifier": "19275B",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Durable Medical Equipment & Medical Supplies in Port Saint Lucie, FL
• Providers in Port Saint Lucie, FL by specialty
• Durable Medical Equipment & Medical Supplies in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 30, 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.