Ideal Optical Inc

Primary specialty

OpticianTaxonomy code 156FX1800X

Legal business name

IDEAL OPTICAL INC

Practice address

6873A North 9TH Ave
Ideal Optical Inc
Pensacola, FL 32504-7349

Phone

(850) 477-0582

NPI assigned

Dec 20, 2006

Organization subpart

No

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

Authorized official

Name

Mr. Fred L Putnam, OPTICIAN

Title

President

Phone

(850) 477-0582

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

Locations

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

{
    "created_epoch": "1166572800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1508920299",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6873A NORTH 9TH AVE",
            "address_2": "IDEAL OPTICAL INC",
            "city": "PENSACOLA",
            "state": "FL",
            "postal_code": "325047349",
            "telephone_number": "850-477-0582"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6873A NORTH 9TH AVE",
            "address_2": "IDEAL OPTICAL INC",
            "city": "PENSACOLA",
            "state": "FL",
            "postal_code": "325047349",
            "telephone_number": "850-477-0582"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IDEAL OPTICAL INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-20",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "PUTNAM",
        "authorized_official_first_name": "FRED",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "850-477-0582",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "OPTICIAN"
    },
    "taxonomies": [
        {
            "code": "156FX1800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Technician/Technologist, Optician",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FLORIDA BS",
            "identifier": "D5664",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Mudasser Ibrahim, MD
• Sherif Ibrahim, M.D.
• Roger D Iburg
• Mackenzie Keir Ikenberry, MS CGC
• Nada Samir Ilia, D.M.D.
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• John Toby Imm, B.C.O.
• Ana Imtiaz, MBBS

• Optician in Pensacola, FL
• Providers in Pensacola, FL by specialty
• Optician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.