Active NPI
Thomas Lee Pendergrast, O.D.
- Optometrist
- Panama City, FL
National Provider Identifier
1295828960
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- OP2933
- Practice address
- 725 N Tyndall Pkwy
Panama City, FL 32404-3219 - Phone
- (850) 785-3426
- NPI assigned
- Oct 2, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | OP2933 | FL | Primary |
Addresses
Primary practice location
725 N Tyndall Pkwy
Panama City, FL 32404-3219
Mailing address
1232 Plantation Dr
Panama City, FL 32404-8637
Phone (850) 874-9803
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
| License | State | Type | Specialty |
|---|---|---|---|
| OP2933 | FL | MD | Optometrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159747200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1295828960",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1232 PLANTATION DR",
"city": "PANAMA CITY",
"state": "FL",
"postal_code": "324048637",
"telephone_number": "850-874-9803"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "725 N TYNDALL PKWY",
"city": "PANAMA CITY",
"state": "FL",
"postal_code": "324043219",
"telephone_number": "850-785-3426"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PENDERGRAST",
"first_name": "THOMAS",
"middle_name": "LEE",
"name_prefix": "Dr.",
"credential": "O.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-10-02",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "FL",
"license": "OP2933",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Panama City, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.