Palm Coast Eyewear, LLC

Primary specialty

Eyewear SupplierTaxonomy code 332H00000X

License

DO1765 Issued in FL

Legal business name

PALM COAST EYEWEAR, LLC

Practice address

5601 21St Ave W
Suite C
Bradenton, FL 34209-5642

Phone

(941) 794-1001

Fax

(941) 794-3280

NPI assigned

Apr 16, 2007

Organization subpart

No

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

Authorized official

Name

Lisa Renee Nichols

Title

Practice Manager

Phone

(941) 794-2020

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Rebecca R Matchok, O.D.

  • Optometrist
  • Bradenton, FL
  • NPI 1740285659
  NPD (past)
• Dana James Weinkle, M.D.

  • Ophthalmology Physician
  • Bradenton, FL
  • NPI 1003807116
  NPD (past)

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

{
    "created_epoch": "1176681600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1210204800000",
    "number": "1396960415",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5601 21ST AVE W",
            "address_2": "SUITE C",
            "city": "BRADENTON",
            "state": "FL",
            "postal_code": "342095642",
            "telephone_number": "941-794-1001",
            "fax_number": "941-794-3280"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5601 21ST AVE W",
            "address_2": "SUITE C",
            "city": "BRADENTON",
            "state": "FL",
            "postal_code": "342095642",
            "telephone_number": "941-794-1001",
            "fax_number": "941-794-3280"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PALM COAST EYEWEAR, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-16",
        "last_updated": "2008-05-08",
        "status": "A",
        "authorized_official_last_name": "NICHOLS",
        "authorized_official_first_name": "LISA",
        "authorized_official_middle_name": "RENEE",
        "authorized_official_title_or_position": "PRACTICE MANAGER",
        "authorized_official_telephone_number": "941-794-2020"
    },
    "taxonomies": [
        {
            "code": "332H00000X",
            "taxonomy_group": "",
            "desc": "Eyewear Supplier",
            "state": "FL",
            "license": "DO1765",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OPTICIAN LICENSE",
            "identifier": "DO1765",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Liliana Palacio, MD
• Victoria Mae Palazzo, MT-BC
• Somashekar Pallegar, MD ABFP FRCS DA FPA
• Palm Chiropractic & Wellness Inc
• Palm Coast Eye Center, P.a.
• Palm Grove Speech Therapy LLC
• Palma Sola Neurology Associates
• Palma Sola Therapies LLC
• Jonathan Joseph Palmer, PHARMD
• Celestino Palomino, M.D.

• Eyewear Supplier in Bradenton, FL
• Providers in Bradenton, FL by specialty
• Eyewear Supplier in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 8, 2008; 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.