Individual provider Active NPI

Cheryl L Diferdinando, O.D.

  • Optometrist
  • Deland, FL
National Provider Identifier
1558487595
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
OPC001742 Issued in FL
Practice address
2659 S Woodland Blvd
Deland, FL 32720-8601
Phone
(386) 736-3579
Fax
(386) 736-6447
NPI assigned
Mar 21, 2007
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X OPC001742 FL Primary

Addresses

Primary practice location

2659 S Woodland Blvd
Deland, FL 32720-8601

Mailing address

2659 S Woodland Blvd
Deland, FL 32720-8601
Phone (386) 736-3579

Other identifiers 1

IdentifierTypeStateIssuer
078632200MedicaidFL

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
I20101122000925 FL Practitioner - Optometry 2668668260

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
OPC001742FLMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Diferdinando & Diferdinando PA Optometrist CurrentSince Oct 27, 2010 Accepting new patients
Visionworks Inc Past Accepting new patients

Locations

2659 S Woodland Blvd
Deland, FL 32720
Phone (386) 736-3579

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": "1174435200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1558487595",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2659 S WOODLAND BLVD",
            "city": "DELAND",
            "state": "FL",
            "postal_code": "327208601",
            "telephone_number": "386-736-3579",
            "fax_number": "386-736-6447"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2659 S WOODLAND BLVD",
            "city": "DELAND",
            "state": "FL",
            "postal_code": "327208601",
            "telephone_number": "386-736-3579",
            "fax_number": "386-736-6447"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DIFERDINANDO",
        "first_name": "CHERYL",
        "middle_name": "L",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-03-21",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "FL",
            "license": "OPC001742",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "078632200",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Deland, FL

Sources for this page

Verify at the official NPI Registry.