Individual provider Active NPI

Jacqueline Dell Gunn, O.D.

  • Optometrist
  • Wilton Manors, FL
National Provider Identifier
1356645261
Registry record updated Jan 6, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
OPC-004134 Issued in FL
Practice address
2228 Wilton Drive
Chic Optique
Wilton Manors, FL 33305
Phone
(954) 567-3937
Fax
(954) 567-3993
NPI assigned
Jan 6, 2011
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 6, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X OPC-004134 FL Primary

Addresses

Primary practice location

2228 Wilton Drive
Chic Optique
Wilton Manors, FL 33305

Mailing address

2228 Wilton Drive
Chic Optique
Wilton Manors, FL 33305
Phone (954) 567-3937

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)
Not enrolled

State licenses

LicenseStateTypeSpecialty
OPC-004134FLMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Brian a. Asalone, O.D., P.a. Optometrist PastSince Apr 9, 2016 Accepting new patients

Organizations & group practices 1

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": "1294272000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1294272000000",
    "number": "1356645261",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2228 WILTON DRIVE",
            "address_2": "CHIC OPTIQUE",
            "city": "WILTON MANORS",
            "state": "FL",
            "postal_code": "33305",
            "telephone_number": "954-567-3937",
            "fax_number": "954-567-3993"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2228 WILTON DRIVE",
            "address_2": "CHIC OPTIQUE",
            "city": "WILTON MANORS",
            "state": "FL",
            "postal_code": "33305",
            "telephone_number": "954-567-3937",
            "fax_number": "954-567-3993"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GUNN",
        "first_name": "JACQUELINE",
        "middle_name": "DELL",
        "name_prefix": "Mrs.",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-01-06",
        "last_updated": "2011-01-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "FL",
            "license": "OPC-004134",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wilton Manors, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 6, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.