Beach Vision Holdings, PA

Primary specialty

OptometristTaxonomy code 152W00000X

License

OPC 1689 Issued in FL

Legal business name

BEACH VISION HOLDINGS, PA

Doing business as

Beach Vision Center

Practice address

103 Faulkner St
New Smyrna Beach, FL 32168-7017

Phone

(396) 423-7788

Fax

(386) 423-0035

NPI assigned

Mar 29, 2012

Last updated

Aug 20, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Susan Simpson SullenbergerNPI 1700092350

Title

Authorized Official

Phone

(386) 547-1549

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 2

• Beach Vision Center Doing business as
• Charles D Register OD, PA Former legal business name

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Susan Simpson Sullenberger, O.D.

  • Optometrist
  • Deland, FL
  • NPI 1700092350
  Medicare reassignment Care Compare group NPD Authorized official
• Kevin Bruce Brantley, O.D.

  • Optometrist
  • Deland, FL
  • NPI 1720123490
  Medicare reassignment Care Compare group NPD
• Charles D Register, OD

  • Optometrist
  • New Smyrna Beach, FL
  • NPI 1053493361
  Medicare reassignment Care Compare group

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

{
    "created_epoch": "1332979200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1724112000000",
    "number": "1346516747",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "103 FAULKNER ST",
            "city": "NEW SMYRNA BEACH",
            "state": "FL",
            "postal_code": "321687017",
            "telephone_number": "396-423-7788",
            "fax_number": "386-423-0035"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "103 FAULKNER ST",
            "city": "NEW SMYRNA BEACH",
            "state": "FL",
            "postal_code": "321687017",
            "telephone_number": "396-423-7788",
            "fax_number": "386-423-0035"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BEACH VISION HOLDINGS, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-03-29",
        "last_updated": "2024-08-20",
        "certification_date": "2024-08-20",
        "status": "A",
        "authorized_official_last_name": "SULLENBERGER",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_middle_name": "SIMPSON",
        "authorized_official_title_or_position": "AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "386-547-1549"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "FL",
            "license": "OPC 1689",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "078276900",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Beach Vision Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Charles D Register OD, PA",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Kristine Bartholdson
• Rachel Bartlett Messick, LM, CPM
• Grey Asher Batchelder, RPH
• Bay View Urgent Care LLC
• Be Well Chiropractic, Inc. (Be Well: A Chiropractic Wellness Community)
• Beachside Medical Center
• Beachside Opco LLC
• Beachside Therapy Services, LLC
• Michelle Leigh Beaulieu, LMT
• Katherine Ann Becker, A.R.N.P.

• Optometrist in New Smyrna Beach, FL
• Providers in New Smyrna Beach, FL by specialty
• Optometrist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 2024; 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.