NPIMap

Organization Active NPI

Optimal Vision Optometry LLC

  • Optometrist
  • Fort Myers, FL
National Provider Identifier
1609498856
Registry record updated Mar 29, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
Legal business name
OPTIMAL VISION OPTOMETRY LLC
Doing business as
Riverside Family Eye Care
Practice address
11841 Palm Beach Blvd Unit 117
Fort Myers, FL 33905-5914
Phone
(239) 500-2020
Fax
(239) 500-2030
NPI assigned
May 11, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 29, 2021

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

Authorized official

Name
Brittany Ann Degler, ODNPI 1275088783
Title
MGRM
Phone
(239) 500-2020

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

11841 Palm Beach Blvd Unit 117
Fort Myers, FL 33905-5914

Mailing address

11841 Palm Beach Blvd Unit 117
Fort Myers, FL 33905-5914
Phone (239) 500-2020

Other names 1

  • Riverside Family Eye Care Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200713001552 FL Part B Supplier - Clinic/Group Practice 2860815644 Receives reassigned benefits from 3 practitioners
Practice locations: Fort Myers, FL

National Provider Directory

National Provider Directory

Locations

11841 Palm Beach Blvd
Unit 117
Fort Myers, FL 33905
Phone (239) 500-2020

Practitioners & affiliated clinicians

Practitioners 3

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": "1589155200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1616976000000",
    "number": "1609498856",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11841 PALM BEACH BLVD UNIT 117",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339055914",
            "telephone_number": "239-500-2020",
            "fax_number": "239-500-2030"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11841 PALM BEACH BLVD UNIT 117",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339055914",
            "telephone_number": "239-500-2020",
            "fax_number": "239-500-2030"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OPTIMAL VISION OPTOMETRY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-05-11",
        "last_updated": "2021-03-29",
        "certification_date": "2020-08-26",
        "status": "A",
        "authorized_official_last_name": "DEGLER",
        "authorized_official_first_name": "BRITTANY",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "MGRM",
        "authorized_official_telephone_number": "239-500-2020",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Riverside Family Eye Care",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Riverside Family Eye Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fort Myers, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 29, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.