Space Coast Eye Care Inc.

Primary specialty

OptometristTaxonomy code 152W00000X

License

OPC4290 Issued in FL

Legal business name

SPACE COAST EYE CARE INC.

Practice address

1051 Port Malabar Blvd NE Ste 14
Palm Bay, FL 32905-5153

Phone

(321) 474-0491

Fax

(321) 723-9397

NPI assigned

Dec 5, 2011

Last updated

Dec 5, 2011By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Christopher M Allen, O.D.NPI 1366530727

Title

Optometrist/President

Phone

(321) 723-9350

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Locations

Practitioners 2

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.

• Christopher Michael Allen, O.D.

  • Optometrist
  • Palm Bay, FL
  • NPI 1366530727
  Medicare reassignment NPD Authorized official
• Carl E Doughty

  • Optometrist
  • Palm Bay, FL
  • NPI 1962594119
  NPD (past)

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

{
    "created_epoch": "1323043200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1323043200000",
    "number": "1619245644",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1051 PORT MALABAR BLVD NE STE 14",
            "city": "PALM BAY",
            "state": "FL",
            "postal_code": "329055153",
            "telephone_number": "321-474-0491",
            "fax_number": "321-723-9397"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1051 PORT MALABAR BLVD NE STE 14",
            "city": "PALM BAY",
            "state": "FL",
            "postal_code": "329055153",
            "telephone_number": "321-474-0491",
            "fax_number": "321-723-9397"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPACE COAST EYE CARE INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-12-05",
        "last_updated": "2011-12-05",
        "status": "A",
        "authorized_official_last_name": "ALLEN",
        "authorized_official_first_name": "CHRISTOPHER",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "OPTOMETRIST/PRESIDENT",
        "authorized_official_telephone_number": "321-723-9350",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "FL",
            "license": "OPC4290",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• South Brevard Behavioral Medicine
• South Brevard Holistic Center, Inc.
• Erin L Soyka
• Space Coast Center for Sexual Health LLC
• Space Coast Chiropractic & Acupuncture
• Space Coast Hospitalists LLC
• Space Coast Medical Management LLC
• Space Coast Neurology and Pain Management PA
• Space Coast Podiatry LLC
• Space Coast Total Health Care

• Optometrist in Palm Bay, FL
• Providers in Palm Bay, FL by specialty
• Optometrist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 5, 2011; 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.