Active NPI
Paula Jayne Boisclair, OPTICIAN
- Optician
- St Petersburg, FL
National Provider Identifier
1649562489
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optician
- License
- 4195
- Practice address
- 4399 35TH St N
St Petersburg, FL 33714-3722 - Phone
- (727) 525-3959
- Fax
- (727) 527-9695
- NPI assigned
- May 12, 2011
- Sex
- Female
- 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 | 4195 | FL | Primary |
Addresses
Primary practice location
4399 35TH St N
St Petersburg, FL 33714-3722
Mailing address
4399 35TH St N
St Petersburg, FL 33714-3722
Phone (727) 525-3959
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 630114200 | 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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4195 | FL | MD | Optician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1305158400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1305158400000",
"number": "1649562489",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4399 35TH ST N",
"city": "ST PETERSBURG",
"state": "FL",
"postal_code": "337143722",
"telephone_number": "727-525-3959",
"fax_number": "727-527-9695"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4399 35TH ST N",
"city": "ST PETERSBURG",
"state": "FL",
"postal_code": "337143722",
"telephone_number": "727-525-3959",
"fax_number": "727-527-9695"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOISCLAIR",
"first_name": "PAULA",
"middle_name": "JAYNE",
"credential": "OPTICIAN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-05-12",
"last_updated": "2011-05-12",
"status": "A"
},
"taxonomies": [
{
"code": "156FX1800X",
"taxonomy_group": "",
"desc": "Technician/Technologist, Optician",
"state": "FL",
"license": "4195",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "630114200",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in St Petersburg, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 12, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.