Individual provider Active NPI

Mark Thomas Marciano, O D

  • Optometrist
  • West Palm Beach, FL
National Provider Identifier
1528064656
Registry record updated Mar 23, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
OP3248 Issued in FL
Practice address
1788 N. Jog Rd.
West Palm Beach, FL 33411-0000
Phone
(561) 242-1200
Fax
(561) 242-1291
NPI assigned
Jun 23, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 23, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X OP3248 FL Primary

Addresses

Primary practice location

1788 N. Jog Rd.
West Palm Beach, FL 33411-0000

Mailing address

1788 N. Jog Rd.
West Palm Beach, FL 33411-0000
Phone (561) 242-1200

Other identifiers 1

IdentifierTypeStateIssuer
620930100MedicaidFL

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
I20040922000215 FL Practitioner - Optometry 7012985609 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Other, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Marciano Family Vision Associates PAGroup PAC ID 6103167523, 4 clinicians
Marciano Family OptometricGroup PAC ID 3577531169, 4 clinicians

Practice addresses (Care Compare)

11380 Prosperity Farms Rd
Suite 120
Palm Beach Gardens, FL 33410-3464
Phone (561) 627-1114

1788 N Jog Rd
West Palm Beach, FL 33411-2500
Phone (561) 242-1200

Procedures performed for Medicare patients

ProcedureNumber of procedures
Cataract surgery1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
OP3248FLMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Marciano Family Vision Associates PA Optometrist CurrentSince Mar 3, 2019 Accepting new patients
Marciano Family Optometric Optometrist CurrentSince Sep 1, 2004 Accepting new patients

Locations

11380 Prosperity Farms Rd
Ste 120
Palm Beach Gardens, FL 33410
Phone (561) 627-1114

1788 N Jog Rd
West Palm Beach, FL 33411
Phone (561) 242-1200

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": "1119484800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1427068800000",
    "number": "1528064656",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1788 N. JOG RD.",
            "city": "WEST PALM BEACH",
            "state": "FL",
            "postal_code": "334110000",
            "telephone_number": "561-242-1200",
            "fax_number": "561-242-1291"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1788 N. JOG RD.",
            "city": "WEST PALM BEACH",
            "state": "FL",
            "postal_code": "334110000",
            "telephone_number": "561-242-1200",
            "fax_number": "561-242-1291"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARCIANO",
        "first_name": "MARK",
        "middle_name": "THOMAS",
        "credential": "O D",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-23",
        "last_updated": "2015-03-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "FL",
            "license": "OP3248",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "620930100",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in West Palm Beach, FL

Sources for this page

Verify at the official NPI Registry.