Active NPI
William J. Mallon, MD
- Eyewear Supplier
- Vero Beach, FL
National Provider Identifier
1376569038
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Eyewear Supplier
- License
- DO2093
- Legal business name
- WILLIAM J. MALLON, MD
- Practice address
- 3500 US Highway 1
Vero Beach, FL 32960-4511 - Phone
- (772) 770-0113
- Fax
- (772) 299-1455
- NPI assigned
- Jul 14, 2006
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mary A Pena-Roque
- Title
- Optician
- Phone
- (772) 770-0113
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Eyewear Supplier | 332H00000X | DO2093 | FL | Primary |
Addresses
Primary practice location
3500 US Highway 1
Vero Beach, FL 32960-4511
Mailing address
3500 US Highway 1
Vero Beach, FL 32960-4511
Phone (772) 770-0113
Other names 1
- Advanced Optical
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in FL
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20100930062010 | FL | DME Supplier - Physician - Ophthalmology | 9234039116 | Practice locations: Vero Beach, FL |
Other NPIs with the same Medicare PAC ID 1
NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).
National Provider Directory
National Provider Directory- Tax ID family
- William J Mallon MD PA
Other organizations with this tax ID 2
Organizations that report the same tax identification number in the National Provider Directory.
-
- Non-Pharmacy Dispensing Site
- Fort Pierce, FL
- NPI 1336906221
-
- Ophthalmology Physician
- Vero Beach, FL
- NPI 1649353582
Practitioners & affiliated clinicians
Practitioners 1
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Ophthalmology Physician
- Vero Beach, FL
- NPI 1114976479
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1152835200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1437004800000",
"number": "1376569038",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3500 US HIGHWAY 1",
"city": "VERO BEACH",
"state": "FL",
"postal_code": "329604511",
"telephone_number": "772-770-0113",
"fax_number": "772-299-1455"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3500 US HIGHWAY 1",
"city": "VERO BEACH",
"state": "FL",
"postal_code": "329604511",
"telephone_number": "772-770-0113",
"fax_number": "772-299-1455"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "WILLIAM J. MALLON, MD",
"organizational_subpart": "NO",
"enumeration_date": "2006-07-14",
"last_updated": "2015-07-16",
"status": "A",
"authorized_official_last_name": "PENA-ROQUE",
"authorized_official_first_name": "MARY",
"authorized_official_middle_name": "A",
"authorized_official_title_or_position": "OPTICIAN",
"authorized_official_telephone_number": "772-770-0113"
},
"taxonomies": [
{
"code": "332H00000X",
"taxonomy_group": "",
"desc": "Eyewear Supplier",
"state": "FL",
"license": "DO2093",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "Advanced Optical",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Vero Beach, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.