Individual provider Active NPI

Amanda Leigh Brown, O.D.

  • Optometrist
  • Jacksonville, FL
National Provider Identifier
1508809559
Registry record updated Feb 27, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
OPC4100 Issued in FL
Practice address
9525 Crosshill Blvd
Jacksonville, FL 32222-5812
Phone
(904) 573-9482
Fax
(904) 573-9945
NPI assigned
Jun 14, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 27, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Corneal and Contact Management Optometrist 152WC0802X OPC4100 FL
Optometrist 152W00000X OPC4100 FL Primary

Addresses

Primary practice location

9525 Crosshill Blvd
Jacksonville, FL 32222-5812

Mailing address

30 Tavernier Dr Unit C
Ponte Vedra, FL 32081-0677
Phone (904) 686-2897

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
I20051123000014 FL Practitioner - Optometry 1759301583 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Other, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Jax Vision Care, PAGroup PAC ID 8426185927, 4 clinicians

Practice addresses (Care Compare)

30 Tavernier Dr
Unit C
Ponte Vedra, FL 32081-0677
Phone (904) 356-9431

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
OPC4100FLMDCorneal and Contact Management Optometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Jax Vision Care, PA Optometrist CurrentSince May 15, 2024 Accepting new patients
Frank a Broome Jr O.D. Optometrist Past Accepting new patients

Locations

201 N Hogan St
Ste 100
Jacksonville, FL 32202
Phone (904) 356-9431

5255 Dunn Ave
Jacksonville, FL 32218
Phone (904) 751-6211

30 Tavernier Dr
Ste C
Ponte Vedra, FL 32081
Phone (904) 356-9431

Organizations & group practices 2

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": "1150243200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1740614400000",
    "number": "1508809559",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30 TAVERNIER DR UNIT C",
            "city": "PONTE VEDRA",
            "state": "FL",
            "postal_code": "320810677",
            "telephone_number": "904-686-2897",
            "fax_number": "904-834-2169"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9525 CROSSHILL BLVD",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322225812",
            "telephone_number": "904-573-9482",
            "fax_number": "904-573-9945"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROWN",
        "first_name": "AMANDA",
        "middle_name": "LEIGH",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-14",
        "last_updated": "2025-02-27",
        "certification_date": "2025-02-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152WC0802X",
            "taxonomy_group": "",
            "desc": "Optometrist, Corneal and Contact Management",
            "state": "FL",
            "license": "OPC4100",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "FL",
            "license": "OPC4100",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jacksonville, FL

Sources for this page

Verify at the official NPI Registry.