Individual provider Active NPI

Sandra Lee Eveleth, O.D.

  • Optometrist
  • Fort Myers, FL
National Provider Identifier
1366502585
Registry record updated Jul 9, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
OPC2463 Issued in FL
Practice address
8801 College Pkwy
Suite 3
Fort Myers, FL 33919-4882
Phone
(239) 437-2004
Fax
(239) 437-0501
NPI assigned
Dec 11, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 9, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X OPC2463 FL Primary

Addresses

Primary practice location

8801 College Pkwy
Suite 3
Fort Myers, FL 33919-4882

Mailing address

8801 College Pkwy
Suite 3
Fort Myers, FL 33919-4882
Phone (239) 437-2004

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)
Enrolled

State licenses

LicenseStateTypeSpecialty
OPC2463FLMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
National Vision, Inc. Past Accepting new patients
Fort Myers Eye Associates PA Optometrist PastSince Aug 19, 2002 Accepting new patients
National Vision, Inc. Past Accepting new patients

Organizations & group practices 3

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": "1165795200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1366502585",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8801 COLLEGE PKWY",
            "address_2": "SUITE 3",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339194882",
            "telephone_number": "239-437-2004",
            "fax_number": "239-437-0501"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8801 COLLEGE PKWY",
            "address_2": "SUITE 3",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339194882",
            "telephone_number": "239-437-2004",
            "fax_number": "239-437-0501"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EVELETH",
        "first_name": "SANDRA",
        "middle_name": "LEE",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-12-11",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "FL",
            "license": "OPC2463",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Myers, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; 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.