Mark Humphries Jr., OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

OPC001159 Issued in FL

Practice address

21611 Village Lakes Shopping Center
Land O Lakes, FL 34639-5102

Phone

(813) 949-1982

Fax

(813) 949-0422

NPI assigned

Sep 20, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Other identifiers 4

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• Dunnellon Eye Care LLC

  • Optometrist
  • Dunnellon, FL
  • NPI 1528574753
  NPD (past)
• Kathleen D. Wooster, O.D., P.a.

  • Optometrist
  • Brooksville, FL
  • NPI 1174855779
  NPD (past)

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

{
    "created_epoch": "1158710400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1219363200000",
    "number": "1467550731",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21611 VILLAGE LAKES SHOPPING CENTER",
            "city": "LAND O LAKES",
            "state": "FL",
            "postal_code": "346395102",
            "telephone_number": "813-949-1982",
            "fax_number": "813-949-0422"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21611 VILLAGE LAKES SHOPPING CENTER",
            "city": "LAND O LAKES",
            "state": "FL",
            "postal_code": "346395102",
            "telephone_number": "813-949-1982",
            "fax_number": "813-949-0422"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HUMPHRIES",
        "first_name": "MARK",
        "name_prefix": "Mr.",
        "name_suffix": "Jr.",
        "credential": "OD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-09-20",
        "last_updated": "2008-08-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "FL",
            "license": "OPC001159",
            "primary": true
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "LA",
            "license": "776",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MS",
            "license": "674",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DAVIS",
            "identifier": "38918",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "084928600",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS FL",
            "identifier": "19161A",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AUMED",
            "identifier": "101718",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ivelisse Howard-Santiago
• Tera Kathryn Howell
• Santiago M. Hoyos, M.D., P.A.
• Joanne Conger Huber, LCSW
• Heather Hughes
• Eliany Humpierre Aguero, RBT
• Elayne Humpierre, RBT
• April Hurley, BCBA
• Alexis Huskey
• Lesley Ann Hutchinson, RN

• Optometrist in Land O Lakes, FL
• Providers in Land O Lakes, FL by specialty
• Optometrist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 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.