Active NPI
Alan Ivan Rauchwarger, OD
- Optometrist
- Jacksonville, FL
National Provider Identifier
1649298027
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- OPC 1046
- Practice address
- 9400 Atlantic Blvd
62
Jacksonville, FL 32225-8255 - Phone
- (904) 721-7700
- Fax
- (904) 721-0051
- NPI assigned
- Jul 17, 2006
- 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 |
|---|---|---|---|---|
| Optometrist | 152W00000X | OPC 1046 | FL | Primary |
Addresses
Primary practice location
9400 Atlantic Blvd
62
Jacksonville, FL 32225-8255
Mailing address
9400 Atlantic Blvd
Suite 62
Jacksonville, FL 32225-8255
Phone (904) 721-7700
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 011047500 | Medicaid | FL |
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| OPC 1046 | FL | MD | Optometrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153094400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1424822400000",
"number": "1649298027",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9400 ATLANTIC BLVD",
"address_2": "SUITE 62",
"city": "JACKSONVILLE",
"state": "FL",
"postal_code": "322258255",
"telephone_number": "904-721-7700",
"fax_number": "904-721-0051"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9400 ATLANTIC BLVD",
"address_2": "62",
"city": "JACKSONVILLE",
"state": "FL",
"postal_code": "322258255",
"telephone_number": "904-721-7700",
"fax_number": "904-721-0051"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RAUCHWARGER",
"first_name": "ALAN",
"middle_name": "IVAN",
"credential": "OD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-17",
"last_updated": "2015-02-25",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "FL",
"license": "OPC 1046",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "011047500",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Jacksonville, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 25, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.