Soutel Optical

Primary specialty

Occupational Vision OptometristTaxonomy code 152WX0102X

License

OB2437 Issued in FL

Legal business name

SOUTEL OPTICAL

Practice address

5353 Soutel Dr Suite B
Jacksonville, FL 32219-3492

Phone

(904) 766-0660

Fax

(904) 766-8338

NPI assigned

Apr 24, 2008

Organization subpart

No

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

Authorized official

Name

Dr. Gary Otega Williams, O.D.

Title

Owner

Phone

(904) 766-0660

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1208995200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1208995200000",
    "number": "1457526147",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5353 SOUTEL DR SUITE B",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322193492",
            "telephone_number": "904-766-0660",
            "fax_number": "904-766-8338"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5353 SOUTEL DR SUITE B",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322193492",
            "telephone_number": "904-766-0660",
            "fax_number": "904-766-8338"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTEL OPTICAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-04-24",
        "last_updated": "2008-04-24",
        "status": "A",
        "authorized_official_last_name": "WILLIAMS",
        "authorized_official_first_name": "GARY",
        "authorized_official_middle_name": "OTEGA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "904-766-0660",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152WX0102X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist, Occupational Vision",
            "state": "FL",
            "license": "OB2437",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 24, 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.