Individual provider Active NPI

Tatiana Sophia Mastriano, OD

  • Optometrist
  • Palm City, FL
National Provider Identifier
1356190763
Registry record updated May 27, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
OPC6688 Issued in FL
Practice address
2660 SW Immanuel Dr
Palm City, FL 34990-2738
Phone
(772) 283-1191
NPI assigned
May 16, 2024
Last updated
May 27, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 27, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X OPC6688 FL Primary

Addresses

Primary practice location

2660 SW Immanuel Dr
Palm City, FL 34990-2738

Mailing address

2080 SW Cimarron CT
Palm City, FL 34990-5743
Phone (954) 668-5811

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
I20250616001464 FL Practitioner - Optometry 6709397920 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
J.S. Davis LLCGroup PAC ID 4385902006, 4 clinicians

Practice addresses (Care Compare)

2660 SW Immanuel Dr
Palm City, FL 34990-2738
Phone (772) 283-1191

Procedures performed for Medicare patients

ProcedureNumber of procedures
Cataract surgery1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
OPC6688FLMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Debra a. Shim, O.D., P.a. Optometrist CurrentSince Jun 5, 2025 Accepting new patients
J.S. Davis L.L.C. Optometrist CurrentSince Jun 2, 2025 Accepting new patients
Stephen B Allison Optometrist PastSince May 19, 2024 Accepting new patients
Debra a. Shim, OD, PA PastSince Jun 5, 2025 Accepting new patients

Locations

451 University Blvd
Ste 102
Jupiter, FL 33458
Phone (561) 625-4380

2660 SW Immanuel Dr
Palm City, FL 34990
Phone (772) 283-1191

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1715817600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1748304000000",
    "number": "1356190763",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2080 SW CIMARRON CT",
            "city": "PALM CITY",
            "state": "FL",
            "postal_code": "349905743",
            "telephone_number": "954-668-5811"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2660 SW IMMANUEL DR",
            "city": "PALM CITY",
            "state": "FL",
            "postal_code": "349902738",
            "telephone_number": "772-283-1191"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MASTRIANO",
        "first_name": "TATIANA",
        "middle_name": "SOPHIA",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-05-16",
        "last_updated": "2025-05-27",
        "certification_date": "2025-05-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "FL",
            "license": "OPC6688",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Palm City, FL

Sources for this page

Verify at the official NPI Registry.