NPIMap

Organization Active NPI

Salomon Eye Care PA

  • Optometrist
  • Winter Haven, FL
National Provider Identifier
1609469352
Registry record updated Jun 7, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
Legal business name
SALOMON EYE CARE PA
Practice address
570 Avenue K SE
Winter Haven, FL 33880-4203
Phone
(863) 401-4200
Fax
(863) 220-9912
NPI assigned
Feb 13, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 7, 2021

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

Authorized official

Name
Dr. Carly N Salomon, ODNPI 1508425679
Title
Doctor/Owner
Phone
(863) 401-4200

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X Primary

Addresses

Primary practice location

570 Avenue K SE
Winter Haven, FL 33880-4203

Mailing address

570 Avenue K SE
Winter Haven, FL 33880-4203
Phone (863) 401-4200

Other identifiers 1

IdentifierTypeStateIssuer
109904700MedicaidFL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20210316000259 FL Part B Supplier - Clinic/Group Practice 9234545393 Receives reassigned benefits from 4 practitioners
Practice locations: Winter Haven, FL
O20211110002563 FL DME Supplier - Physician - Optometrist 9234545393 Practice locations: Winter Haven, FL

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Salomon Eye Care PA570 Avenue K SE, Winter Haven, FL 33880-4203(863) 401-4200 Prosthetic Lenses: Conventional Eyeglasses|Prosthetic Lenses: Conventional Contact Lenses|Prosthetic Lenses: Prosthetics Cataract Lenses Accepts assignmentParticipating since Mar 1, 2021

National Provider Directory

National Provider Directory

Locations

570 Avenue K SE
Winter Haven, FL 33880
Phone (863) 299-6476

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1613174400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1623024000000",
    "number": "1609469352",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "570 AVENUE K SE",
            "city": "WINTER HAVEN",
            "state": "FL",
            "postal_code": "338804203",
            "telephone_number": "863-401-4200",
            "fax_number": "863-220-9912"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "570 AVENUE K SE",
            "city": "WINTER HAVEN",
            "state": "FL",
            "postal_code": "338804203",
            "telephone_number": "863-401-4200",
            "fax_number": "863-220-9912"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SALOMON EYE CARE PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-02-13",
        "last_updated": "2021-06-07",
        "certification_date": "2021-06-07",
        "status": "A",
        "authorized_official_last_name": "SALOMON",
        "authorized_official_first_name": "CARLY",
        "authorized_official_middle_name": "N",
        "authorized_official_title_or_position": "DOCTOR/OWNER",
        "authorized_official_telephone_number": "863-401-4200",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "109904700",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Winter Haven, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 7, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.