Individual provider Active NPI

Susan Ann Driscoll, OD

  • Optometrist
  • Altamonte Springs, FL
National Provider Identifier
1578630539
Registry record updated Jan 1, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
OPC2685 Issued in FL
Practice address
451 E Altamonte Dr Ste 1467
Altamonte Springs, FL 32701-4616
Phone
(407) 830-6546
Fax
(407) 830-9132
NPI assigned
Nov 28, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 1, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 04797T TX
Optometrist 152W00000X OPC2685 FL Primary

Addresses

Primary practice location

451 E Altamonte Dr Ste 1467
Altamonte Springs, FL 32701-4616

Mailing address

451 E Altamonte Dr Ste 1467
Altamonte Springs, FL 32701-4616
Phone (407) 830-6546

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
I20110316000179 FL Practitioner - Optometry 8426230228 Practice locations: Altamonte Springs, FL

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
OPC2685FLMDOptometrist
04797TTXMDOptometrist

NPI Registry JSON

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

{
    "created_epoch": "1164672000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1735689600000",
    "number": "1578630539",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "451 E ALTAMONTE DR STE 1467",
            "city": "ALTAMONTE SPRINGS",
            "state": "FL",
            "postal_code": "327014616",
            "telephone_number": "407-830-6546",
            "fax_number": "407-830-9132"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "451 E ALTAMONTE DR STE 1467",
            "city": "ALTAMONTE SPRINGS",
            "state": "FL",
            "postal_code": "327014616",
            "telephone_number": "407-830-6546",
            "fax_number": "407-830-9132"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DRISCOLL",
        "first_name": "SUSAN",
        "middle_name": "ANN",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-28",
        "last_updated": "2025-01-01",
        "certification_date": "2025-01-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "TX",
            "license": "04797T",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "FL",
            "license": "OPC2685",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Altamonte Springs, FL

Sources for this page

Verify at the official NPI Registry.