Palm Coast Eye Center, P.a.

Primary specialty

Ophthalmology PhysicianTaxonomy code 207W00000X

License

ME0045451 Issued in FL

Legal business name

PALM COAST EYE CENTER, P.A.

Practice address

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

Phone

(941) 794-2020

Fax

(941) 792-3464

NPI assigned

Jun 7, 2006

Last updated

Apr 10, 2008By the provider in NPPES

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 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Tax ID family

Palm Coast Eye Center2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Palm Coast Eye Center, P.a.

  • Ophthalmology Physician
  • Sarasota, FL
  • NPI 1053365056
  NPD tax ID

Locations

Practitioners 8

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.

• Jeannene L Dieter, O.D.

  • Optometrist
  • Parrish, FL
  • NPI 1417955451
  Medicare reassignment NPD
• Seth H Oppenheim, MD

  • Ophthalmology Physician
  • Sun City Center, FL
  • NPI 1073587952
  Medicare reassignment NPD
• Mark P Strosser, OD

  • Optometrist
  • St Petersburg, FL
  • NPI 1902800683
  Medicare reassignment NPD
• Dana James Weinkle, M.D.

  • Ophthalmology Physician
  • Bradenton, FL
  • NPI 1003807116
  Medicare reassignment NPD
• Jenette Lynn Cantrell, OD

  • Optometrist
  • Bay Pines, FL
  • NPI 1811000516
  NPD (past)
• Michael Casey Maloney, O.D.

  • Optometrist
  • Sarasota, FL
  • NPI 1013971266
  NPD (past)
• Rebecca R Matchok, O.D.

  • Optometrist
  • Bradenton, FL
  • NPI 1740285659
  NPD (past)
• Jennifer Carol Prunty, O.D.

  • Optometrist
  • Portland, OR
  • NPI 1164738795
  NPD (past)

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

{
    "created_epoch": "1149638400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1207785600000",
    "number": "1427098730",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5601 21ST AVE W",
            "address_2": "SUITE A",
            "city": "BRADENTON",
            "state": "FL",
            "postal_code": "342095642",
            "telephone_number": "941-794-2020",
            "fax_number": "941-792-3464"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5601 21ST AVE W",
            "address_2": "SUITE A",
            "city": "BRADENTON",
            "state": "FL",
            "postal_code": "342095642",
            "telephone_number": "941-794-2020",
            "fax_number": "941-792-3464"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PALM COAST EYE CENTER, P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-07",
        "last_updated": "2008-04-10",
        "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": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "FL",
            "license": "OPC3917",
            "primary": false
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "FL",
            "license": "ME0045451",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE GROUP",
            "identifier": "CJ5917",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Pain Medicine Institute PLLC
• Liliana Palacio, MD
• Victoria Mae Palazzo, MT-BC
• Somashekar Pallegar, MD ABFP FRCS DA FPA
• Palm Chiropractic & Wellness Inc
• Palm Coast Eyewear, LLC
• Palm Grove Speech Therapy LLC
• Palma Sola Neurology Associates
• Palma Sola Therapies LLC
• Jonathan Joseph Palmer, PHARMD

• Ophthalmology Physician in Bradenton, FL
• Providers in Bradenton, FL by specialty
• Ophthalmology Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 10, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.