NPIMap

Organization Active NPI

Patrick L Reardon OD

  • Optometrist
  • Jacksonville, FL
National Provider Identifier
1588054324
Registry record updated Feb 2, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
OPC998 Issued in FL
Legal business name
PATRICK L REARDON OD
Practice address
961 Cesery Blvd
Jacksonville, FL 32211-5678
Phone
(904) 743-9955
Fax
(904) 743-2802
NPI assigned
Feb 2, 2015
Last updated
Feb 2, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 2, 2015

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

Authorized official

Name
Dr. Patrick Reardon, O.D.NPI 1831189646
Title
Owner
Phone
(904) 743-9955

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X OPC998 FL Primary

Addresses

Primary practice location

961 Cesery Blvd
Jacksonville, FL 32211-5678

Mailing address

961 Cesery Blvd
Jacksonville, FL 32211-5678
Phone (904) 743-9955

Other identifiers 3

IdentifierTypeStateIssuer
19736OtherFLFLORIDA BLUE
078642000MedicaidFL
114979OtherFLEYEMED

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1422835200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1422835200000",
    "number": "1588054324",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "961 CESERY BLVD",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322115678",
            "telephone_number": "904-743-9955",
            "fax_number": "904-743-2802"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "961 CESERY BLVD",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322115678",
            "telephone_number": "904-743-9955",
            "fax_number": "904-743-2802"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PATRICK L REARDON OD",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-02-02",
        "last_updated": "2015-02-02",
        "status": "A",
        "authorized_official_last_name": "REARDON",
        "authorized_official_first_name": "PATRICK",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "904-743-9955",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "FL",
            "license": "OPC998",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FLORIDA BLUE",
            "identifier": "19736",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "078642000",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "EYEMED",
            "identifier": "114979",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Jacksonville, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 2, 2015; 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.