Individual provider Active NPI

William Rob Vickers, M.D.

  • Ophthalmology Physician
  • Port Saint Lucie, FL
National Provider Identifier
1639269798
Registry record updated Jun 23, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
License
ME111532 Issued in FL
Practice address
260 NW Peacock Blvd Ste 101
Port Saint Lucie, FL 34986-2349
Phone
(772) 448-4865
Fax
(772) 448-4864
NPI assigned
Oct 12, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 23, 2026

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Ophthalmology Physician 207W00000X 066913 GA
Surgery Physician 208600000X LL28968 SC
Ophthalmology Physician 207W00000X ME111532 FL Primary

Addresses

Primary practice location

260 NW Peacock Blvd Ste 101
Port Saint Lucie, FL 34986-2349

Mailing address

260 NW Peacock Blvd Ste 101
Port Saint Lucie, FL 34986-2349
Phone (772) 448-4865

Other identifiers 1

IdentifierTypeStateIssuer
006123300MedicaidFL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20120702000182 FL Practitioner - Ophthalmology 9234394909 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Ophthalmology
Education
West Virginia University School of Medicine, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

260 NW Peacock Blvd
Suite 101
Port Saint Lucie, FL 34986-2349
Phone (772) 448-4865

Hospital & facility affiliations

  • Cleveland Clinic Martin North Hospital Hospital, Stuart, FL, CCN 100044

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as individual
Promoting interoperability
100
Improvement activities
40

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision45
Skin biopsy1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
066913GAMDOphthalmology Physician
LL28968SCMDSurgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
John E Imhoff MD PC Ophthalmology PastSince Jul 1, 2012 Accepting new patients
Macquaid Eye Institute PastSince Aug 29, 2016 Accepting new patients
Florida Retina Institute James a Staman MD LLC Ophthalmology PastSince Jul 1, 2012 Accepting new patients

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1160611200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1782172800000",
    "number": "1639269798",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "260 NW PEACOCK BLVD STE 101",
            "city": "PORT SAINT LUCIE",
            "state": "FL",
            "postal_code": "349862349",
            "telephone_number": "772-448-4865",
            "fax_number": "772-448-4864"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "260 NW PEACOCK BLVD STE 101",
            "city": "PORT SAINT LUCIE",
            "state": "FL",
            "postal_code": "349862349",
            "telephone_number": "772-448-4865",
            "fax_number": "772-448-4864"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VICKERS",
        "first_name": "WILLIAM",
        "middle_name": "ROB",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-12",
        "last_updated": "2026-06-23",
        "certification_date": "2026-06-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "GA",
            "license": "066913",
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "SC",
            "license": "LL28968",
            "primary": false
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "FL",
            "license": "ME111532",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "006123300",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Port Saint Lucie, FL

Sources for this page

Verify at the official NPI Registry.