Florida Eye Clinic P a
Organization Active NPI Optometrist · Ormond Beach, FL
NPI 1285609461 · NPPES record last updated Dec 21, 2020
Key facts
- NPI
- 1285609461
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Optometrist 152W00000X
- Legal business name
- FLORIDA EYE CLINIC P A
- Practice address
- 1089 W Granada Blvd
#4
Ormond Beach, FL 32174-8299 - Phone
- (386) 676-1300
- Fax
- (386) 372-5073
- NPI assigned
- Feb 21, 2006
- Organization subpart
- Yes
- Parent organization (as reported)
- FLORIDA EYE CLINIC P A
Authorized official
- Name
- Harry Pappas
- Title
- Administrator
- Phone
- (407) 834-7776
Other NPIs on the same Medicare enrollment 15
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in FL
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040126000005 | FL | Part B Supplier - Clinic/Group Practice | 6406758846 |
Receives reassigned benefits from 37 practitioners 15 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Winter Springs, FL; Windermere, FL; Ormond Beach, FL; Orlando, FL; Orange City, FL; Ocoee, FL; Kissimmee, FL; Clermont, FL… |
National Provider Directory
- Part of
- Thomas D Mauger OD
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist |
152W00000X | Yes | ||
| Optician |
156FX1800X | |||
| Ophthalmology Physician |
207W00000X | |||
| Durable Medical Equipment & Medical Supplies | 332B00000X |
Addresses
Primary practice location
1089 W Granada Blvd
#4
Ormond Beach, FL 32174-8299
Mailing address
160 Boston Ave
Altamonte Springs, FL 32701-4706
Phone (407) 339-0303
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 208488110 | Medicaid | FL |
Other providers in Ormond Beach, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 21, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.