Individual provider Active NPI

Jacqueline Rodena, O.D.

  • Optometrist
  • Davie, FL
National Provider Identifier
1336214691
Registry record updated Mar 19, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
OPC3943 Issued in FL
Practice address
3200 S University Dr
Nsu the Eye Institute Suite 1402
Davie, FL 33328-2018
Phone
(954) 262-1402
Fax
(954) 262-1818
NPI assigned
Nov 22, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 19, 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 OPC3943 FL Primary

Addresses

Primary practice location

3200 S University Dr
Nsu the Eye Institute Suite 1402
Davie, FL 33328-2018

Mailing address

PO Box 290370
Davie, FL 33329-0370
Phone (954) 262-4397

Other identifiers 1

IdentifierTypeStateIssuer
078860100MedicaidFL

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
I20041021000360 FL Practitioner - Optometry 3779544994 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Nova Southeastern University Inc. CurrentSince Jul 1, 2010 Accepting new patients
Nova Southeastern University, Inc Optometrist Current Accepting new patients
Nova Southeastern University, Inc CurrentSince Jul 1, 2010 Accepting new patients
Nova Southeastern University, Inc Optometrist PastSince Jul 16, 2023 Accepting new patients

Locations

3200 S University Dr
Davie, FL 33328
Phone (954) 262-1250

3200 S University Dr
Ste 1402
Davie, FL 33328
Phone (954) 262-1402

3200 S University Dr
Bldg 2ND
Davie, FL 33328
Phone (954) 262-4200

1111 W Broward Blvd
Fl 2
Fort Lauderdale, FL 33312
Phone (954) 262-4282

650 N Andrews Ave
Ft Lauderdale, FL 33311
Phone (954) 463-4213

1111 W Broward Blvd
Ft Lauderdale, FL 33312
Phone (954) 463-7313

1750 NE 167th St
North Miami Beach, FL 33162
Phone (305) 949-4000

819 NE 26th St
Wilton Manors, FL 33305
Phone (954) 390-7654

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1164153600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1552953600000",
    "number": "1336214691",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 290370",
            "city": "DAVIE",
            "state": "FL",
            "postal_code": "333290370",
            "telephone_number": "954-262-4397",
            "fax_number": "954-262-2269"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3200 S UNIVERSITY DR",
            "address_2": "NSU THE EYE INSTITUTE SUITE 1402",
            "city": "DAVIE",
            "state": "FL",
            "postal_code": "333282018",
            "telephone_number": "954-262-1402",
            "fax_number": "954-262-1818"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RODENA",
        "first_name": "JACQUELINE",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-22",
        "last_updated": "2019-03-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "FL",
            "license": "OPC3943",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "078860100",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Davie, FL

Sources for this page

Verify at the official NPI Registry.