Philip Desantis, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

OPC 2169 Issued in FL

Practice address

1850 SW Gatlin Blvd
Walmart Optical
Port Saint Lucie, FL 34953-2703

Phone

(772) 343-0003

Fax

(772) 336-9017

NPI assigned

Feb 27, 2007

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Networks

• Freedom Health HMO Network

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.

• Gatlin Vision LLC

  • Optometrist
  • Port St Lucie, FL
  • NPI 1235550120
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1172534400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1291680000000",
    "number": "1386771749",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1850 SW GATLIN BLVD",
            "address_2": "WALMART OPTICAL",
            "city": "PORT SAINT LUCIE",
            "state": "FL",
            "postal_code": "349532703",
            "telephone_number": "772-343-0003",
            "fax_number": "772-336-9017"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1850 SW GATLIN BLVD",
            "address_2": "WALMART OPTICAL",
            "city": "PORT SAINT LUCIE",
            "state": "FL",
            "postal_code": "349532703",
            "telephone_number": "772-343-0003",
            "fax_number": "772-336-9017"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DESANTIS",
        "first_name": "PHILIP",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-02-27",
        "last_updated": "2010-12-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "FL",
            "license": "OPC 2169",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Yohanna Deno, MD
• Dentihealth LLC
• Department of Veterans Affair
• Evelyn Derocher, RRT
• Jacob Derocher, OTR/L
• Donna K Desanto, MSW ACSW
• Thierry Descadres
• Descending Dove Nurse-Midwifery Inc
• Marie Ginette Destin, PERSONAL CAREGIVER
• Keri Destito, ARNP

• Optometrist in Port Saint Lucie, FL
• Providers in Port Saint Lucie, FL by specialty
• Optometrist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 7, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.