NPIMap

Organization Active NPI

Maxim-Eyes Optical, Inc

  • Optician
  • Valrico, FL
National Provider Identifier
1386042026
Registry record updated Dec 11, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
OpticianTaxonomy code 156FX1800X
License
DO4868 Issued in FL
Legal business name
MAXIM-EYES OPTICAL, INC
Practice address
2547 E State Road 60
Valrico, FL 33594-3830
Phone
(813) 653-9661
Fax
(813) 657-4334
NPI assigned
Dec 11, 2014
Last updated
Dec 11, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 11, 2014

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

Authorized official

Name
Dulcie KiffnerNPI 1689799090
Title
President
Phone
(813) 653-9661

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X OPC2050 FL
Optician 156FX1800X DO4868 FL Primary

Addresses

Primary practice location

2547 E State Road 60
Valrico, FL 33594-3830

Mailing address

2547 E State Road 60
Valrico, FL 33594-3830
Phone (813) 653-9661

Other identifiers 2

IdentifierTypeStateIssuer
078763900MedicaidFL
630341200MedicaidFL

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20190108001237 FL Part B Supplier - Clinic/Group Practice 4981940293 Receives reassigned benefits from 1 practitioner
Practice locations: Valrico, FL
O20190222001218 FL DME Supplier - OpticianDME Supplier - Physician - Optometrist 4981940293 Practice locations: Valrico, FL

National Provider Directory

National Provider Directory

Locations

2547 E State Road 60
Valrico, FL 33594
Phone (813) 653-9661

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1418256000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1418256000000",
    "number": "1386042026",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2547 E STATE ROAD 60",
            "city": "VALRICO",
            "state": "FL",
            "postal_code": "335943830",
            "telephone_number": "813-653-9661",
            "fax_number": "813-657-4334"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2547 E STATE ROAD 60",
            "city": "VALRICO",
            "state": "FL",
            "postal_code": "335943830",
            "telephone_number": "813-653-9661",
            "fax_number": "813-657-4334"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAXIM-EYES OPTICAL, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-12-11",
        "last_updated": "2014-12-11",
        "status": "A",
        "authorized_official_last_name": "KIFFNER",
        "authorized_official_first_name": "DULCIE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "813-653-9661"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "FL",
            "license": "OPC2050",
            "primary": false
        },
        {
            "code": "156FX1800X",
            "taxonomy_group": "",
            "desc": "Technician/Technologist, Optician",
            "state": "FL",
            "license": "DO4868",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "078763900",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "630341200",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Valrico, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 11, 2014; 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.

Verify at the official NPI Registry.