NPIMap

Organization Active NPI

Eye Specialists of Mid Florida PA

  • Ophthalmology Physician
  • Winter Haven, FL
National Provider Identifier
1366437162
Registry record updated Mar 1, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
License
601197 Issued in FL
Legal business name
EYE SPECIALISTS OF MID FLORIDA PA
Practice address
407 Avenue K SE
Winter Haven, FL 33880
Phone
(863) 294-3504
Fax
(863) 294-8305
NPI assigned
Sep 19, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 1, 2024

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

Authorized official

Name
Dr. Daniel W Welch, M.D.NPI 1265434427
Title
President
Phone
(863) 294-3504

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ophthalmology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207W00000X 601197 FL Primary

Addresses

Primary practice location

407 Avenue K SE
Winter Haven, FL 33880

Mailing address

407 Avenue K SE
Winter Haven, FL 33880-4126
Phone (863) 294-3504

Other identifiers 7

IdentifierTypeStateIssuer
254876300MedicaidFL
254876302MedicaidFL
254876303MedicaidFL
254876304MedicaidFL
254876306MedicaidFL
254876301MedicaidFL
254876305MedicaidFL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040417000072 FL Part B Supplier - Clinic/Group Practice 8022003235 Receives reassigned benefits from 21 practitioners
Practice locations: Auburndale, FL; Clermont, FL; Haines City, FL; Lake Wales, FL; Lakeland, FL; Sebring, FL; Winter Haven, FL
O20100930027199 FL DME Supplier - Physician - OphthalmologyDME Supplier - Physician - OptometristDME Supplier - Optician 8022003235 Practice locations: Winter Haven, FL

Other NPIs with the same Medicare PAC ID 3

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Eye Specialists of Mid FL PA407 Avenue K SE, Winter Haven, FL 33880-4126(863) 294-3504 Prosthetic Lenses: Conventional Contact Lenses Accepts assignmentParticipating since Jan 1, 2002

National Provider Directory

National Provider Directory
Tax ID family
Scott E Klein DO6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1050 US Highway 27
Clermont, FL 34714
Phone (352) 394-0573

100 Patterson Rd
Haines City, FL 33844
Phone (863) 294-3504

2800 Ridge Way
Ste 1
Lake Wales, FL 33859

2800 Ridge Way
Ste 100A
Lake Wales, FL 33859

2025 E Edgewood Dr
Lakeland, FL 33803
Phone (863) 665-4515

5030 US 27 N
Sebring, FL 33870
Phone (863) 385-1074

Practitioners & affiliated clinicians

Practitioners 21

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 21

NPI Registry JSON

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

{
    "created_epoch": "1127088000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1709251200000",
    "number": "1366437162",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "407 AVENUE K SE",
            "city": "WINTER HAVEN",
            "state": "FL",
            "postal_code": "338804126",
            "telephone_number": "863-294-3504",
            "fax_number": "863-294-8305"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "407 AVENUE K SE",
            "city": "WINTER HAVEN",
            "state": "FL",
            "postal_code": "33880",
            "telephone_number": "863-294-3504",
            "fax_number": "863-294-8305"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EYE SPECIALISTS OF MID FLORIDA PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-09-19",
        "last_updated": "2024-03-01",
        "certification_date": "2024-03-01",
        "status": "A",
        "authorized_official_last_name": "WELCH",
        "authorized_official_first_name": "DANIEL",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "863-294-3504",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Ophthalmology",
            "state": "FL",
            "license": "601197",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "254876300",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "254876302",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "254876303",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "254876304",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "254876306",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "254876301",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "254876305",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Winter Haven, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 1, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.