John S. Geddes III OD PA

Primary specialty

OptometristTaxonomy code 152W00000X

License

OPC2954 Issued in FL

Legal business name

JOHN S. GEDDES III OD PA

Practice address

10250 SE 167TH Place Rd
Suite 4
Summerfield, FL 34491-8686

Phone

(352) 693-2545

Fax

(352) 693-2449

NPI assigned

Dec 24, 2008

Organization subpart

No

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

Authorized official

Name

Dr. John S Geddes III, O.D.

Title

President

Phone

(352) 360-0306

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1230076800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1417651200000",
    "number": "1548406473",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1508 TEXAS CT",
            "city": "TAVARES",
            "state": "FL",
            "postal_code": "327782130",
            "telephone_number": "352-360-0306",
            "fax_number": "352-693-2449"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10250 SE 167TH PLACE RD",
            "address_2": "SUITE 4",
            "city": "SUMMERFIELD",
            "state": "FL",
            "postal_code": "344918686",
            "telephone_number": "352-693-2545",
            "fax_number": "352-693-2449"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JOHN S. GEDDES III OD PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-12-24",
        "last_updated": "2014-12-04",
        "status": "A",
        "authorized_official_last_name": "GEDDES",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "352-360-0306",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "III",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "FL",
            "license": "OPC2954",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "002966600",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 4, 2014; 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.