Individual provider Active NPI

Jesse Villegas, OD

  • Optometrist
  • Kissimmee, FL
National Provider Identifier
1437815461
Registry record updated Nov 15, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
6024 Issued in FL
Practice address
1150 E Vine St
Kissimmee, FL 34744-3579
Phone
(407) 931-2012
NPI assigned
Nov 15, 2021
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 15, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 6024 FL Primary

Addresses

Primary practice location

1150 E Vine St
Kissimmee, FL 34744-3579

Mailing address

1150 E Vine St
Kissimmee, FL 34744-3579
Phone (407) 931-2012

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20211202002075 FL Practitioner - Optometry 1658761895 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Eye Doctors Optical Outlets PAGroup PAC ID 0042123846, 97 clinicians

Practice addresses (Care Compare)

1150 E Vine St
Kissimmee, FL 34744-3579
Phone (407) 931-2012

140 E 13TH St
Saint Cloud, FL 34769-4703
Phone (321) 766-7800

5607 Johns Rd
Tampa, FL 33634-4499
Phone (813) 385-1873

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
6024FLMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Eye Doctors Optical Outlets PA Optometrist Current Accepting new patients
Eye Doctors Optical Outlets PA Optometrist CurrentSince Nov 1, 2021 Accepting new patients
Eye Doctors Optical Outlets PA Optometrist CurrentSince Nov 1, 2021 Accepting new patients

Locations

1150 E Vine St
Kissimmee, FL 34744
Phone (407) 931-2012

140 E 13th St
Saint Cloud, FL 34769
Phone (321) 766-7800

5607 Johns Rd
Tampa, FL 33634
Phone (813) 385-1873

Networks

  • Freedom Health HMO Network

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1636934400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1636934400000",
    "number": "1437815461",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1150 E VINE ST",
            "city": "KISSIMMEE",
            "state": "FL",
            "postal_code": "347443579",
            "telephone_number": "407-931-2012"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1150 E VINE ST",
            "city": "KISSIMMEE",
            "state": "FL",
            "postal_code": "347443579",
            "telephone_number": "407-931-2012"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VILLEGAS",
        "first_name": "JESSE",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-11-15",
        "last_updated": "2021-11-15",
        "certification_date": "2021-11-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "FL",
            "license": "6024",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kissimmee, FL

Sources for this page

Verify at the official NPI Registry.