NPIMap

Organization Active NPI

Anthony J Potochick OD PA

  • Optometrist
  • Jacksonville, FL
National Provider Identifier
1508036658
Registry record updated Oct 21, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
OPC2902 Issued in FL
Legal business name
ANTHONY J POTOCHICK OD PA
Practice address
2036 Forbes St
Jacksonville, FL 32204-3802
Phone
(904) 387-4057
Fax
(904) 387-1026
NPI assigned
Mar 5, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 21, 2011

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

Authorized official

Name
Dr. Anthony James Potochick, ODNPI 1841232287
Title
President
Phone
(907) 387-4057

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X OPC2902 FL Primary

Addresses

Primary practice location

2036 Forbes St
Jacksonville, FL 32204-3802

Mailing address

2036 Forbes St
Jacksonville, FL 32204-3802

Other identifiers 1

IdentifierTypeStateIssuer
621350200MedicaidFL

Other names 1

  • 5 Points Eye Associates Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080324000107 FL Part B Supplier - Clinic/Group Practice 2769568336 Receives reassigned benefits from 1 practitioner
Practice locations: Jacksonville, FL

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

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

NPI Registry JSON

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

{
    "created_epoch": "1204675200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1319155200000",
    "number": "1508036658",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2036 FORBES ST",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322043802",
            "fax_number": "904-387-1026"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2036 FORBES ST",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322043802",
            "telephone_number": "904-387-4057",
            "fax_number": "904-387-1026"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ANTHONY J POTOCHICK OD PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-03-05",
        "last_updated": "2011-10-21",
        "status": "A",
        "authorized_official_last_name": "POTOCHICK",
        "authorized_official_first_name": "ANTHONY",
        "authorized_official_middle_name": "JAMES",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "907-387-4057",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "FL",
            "license": "OPC2902",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "621350200",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "5 Points Eye Associates",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Jacksonville, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.