Anna Latsamy Phidarat, OD
Individual provider Active NPI Optometrist · Oakland, FL
NPI 1376430033 · NPPES record last updated Jun 23, 2025
Key facts
- NPI
- 1376430033
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Optometrist 152W00000X
- License
- OPC6734 (FL)
- Practice address
- 3311 Daniels Rd Ste 102
Oakland, FL 34787-7000 - Phone
- (407) 635-8356
- NPI assigned
- Jun 23, 2025
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in FL
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20250711000919 | FL | Practitioner - Optometry | 0244745198 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| OPC6734 | FL | MD | Optometrist |
Practice roles (1 of 2)
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Treyefecta Vision Holdings, LLC | Optometrist | Current |
Accepting new patients |
Locations
14901 N Dale Mabry Hwy
Tampa, FL 33618
Phone (813) 960-8318
3311 Daniels Rd
Ste 102
Winter Garden, FL 34787
Phone (407) 635-8356
Networks
- Freedom Health HMO Network
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | OPC6734 | FL | Yes |
Addresses
Primary practice location
3311 Daniels Rd Ste 102
Oakland, FL 34787-7000
Mailing address
7146 Conway Road
Unit 1407
Orlando, FL 32812
Other providers in Oakland, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 23, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.