Active NPI
Derwin Jones, LICENSED OPTICIAN
- Optician
- Port St Lucie, FL
National Provider Identifier
1609560580
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optician
- License
- 5848
- Practice address
- 1750 SW Gatlin Blvd
Port St Lucie, FL 34953-2777 - Phone
- (772) 878-1307
- Fax
- (772) 878-1309
- NPI assigned
- Jun 5, 2023
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optician | 156FX1800X | 5848 | FL | Primary |
Addresses
Primary practice location
1750 SW Gatlin Blvd
Port St Lucie, FL 34953-2777
Mailing address
2358 SE Shelter Dr
Port St Lucie, FL 34952-4853
Phone (954) 257-1548
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5848 | FL | MD | Optician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1685923200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1685923200000",
"number": "1609560580",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2358 SE SHELTER DR",
"city": "PORT ST LUCIE",
"state": "FL",
"postal_code": "349524853",
"telephone_number": "954-257-1548"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1750 SW GATLIN BLVD",
"city": "PORT ST LUCIE",
"state": "FL",
"postal_code": "349532777",
"telephone_number": "772-878-1307",
"fax_number": "772-878-1309"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JONES",
"first_name": "DERWIN",
"credential": "LICENSED OPTICIAN",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2023-06-05",
"last_updated": "2023-06-05",
"certification_date": "2023-06-05",
"status": "A"
},
"taxonomies": [
{
"code": "156FX1800X",
"taxonomy_group": "",
"desc": "Technician/Technologist, Optician",
"state": "FL",
"license": "5848",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Port St Lucie, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 5, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.