Optical Shop of Palatka Inc

Primary specialty

Eyewear SupplierTaxonomy code 332H00000X

License

DO889 Issued in FL

Legal business name

OPTICAL SHOP OF PALATKA INC

Practice address

3710 Saint Johns Ave
Palatka, FL 32177-4026

Phone

(386) 328-2020

Fax

(386) 328-6428

NPI assigned

Feb 5, 2008

Organization subpart

No

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

Authorized official

Name

Mr. Lawrence Alan Carroll, OPTICIANNPI 1487772935

Title

Owner

Phone

(386) 328-2020

Specialties & licenses 1

Addresses

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Lawrence Alan Carroll, OPTICIAN

  • Optician
  • Palatka, FL
  • NPI 1487772935
  NPD (past) Authorized official
• Gregory T Kipp, O.D.

  • Optometrist
  • Port Orange, FL
  • NPI 1265488134
  NPD (past)

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

{
    "created_epoch": "1202169600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1202256000000",
    "number": "1669650255",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3710 SAINT JOHNS AVE",
            "city": "PALATKA",
            "state": "FL",
            "postal_code": "321774026",
            "telephone_number": "386-328-2020",
            "fax_number": "386-328-6428"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3710 SAINT JOHNS AVE",
            "city": "PALATKA",
            "state": "FL",
            "postal_code": "321774026",
            "telephone_number": "386-328-2020",
            "fax_number": "386-328-6428"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OPTICAL SHOP OF PALATKA INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-02-05",
        "last_updated": "2008-02-06",
        "status": "A",
        "authorized_official_last_name": "CARROLL",
        "authorized_official_first_name": "LAWRENCE",
        "authorized_official_middle_name": "ALAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "386-328-2020",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "OPTICIAN"
    },
    "taxonomies": [
        {
            "code": "332H00000X",
            "taxonomy_group": "",
            "desc": "Eyewear Supplier",
            "state": "FL",
            "license": "DO889",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Hezekiah George Owojuyigbe, M.D, M.P.H.
• Irena Maria Pacanowska-Assefa, MD
• Anthony J Pacitti, M.D.
• Alfredo A Pairot, DDS

• All providers in Palatka, FL
• Eyewear Supplier in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 6, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.