Jason Wallace, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

OPC4182 Issued in FL

Practice address

502 Celebration Ave
Celebration, FL 34747-4687

Phone

(407) 566-8505

Fax

(407) 566-8253

NPI assigned

Nov 1, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Optometry

Education

Indiana University - School of Optometry, 2006

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Christine Y Blick OD PAGroup PAC ID 0941198899, 2 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

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.

• Christine Y Blick OD PA

  dba Envision Eyecare

  • Optometrist
  • Celebration, FL
  • NPI 1851492201
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1162339200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1510099200000",
    "number": "1689751166",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1921 VARICK WAY",
            "city": "CASSELBERRY",
            "state": "FL",
            "postal_code": "327072410",
            "telephone_number": "407-637-9621"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "502 CELEBRATION AVE",
            "city": "CELEBRATION",
            "state": "FL",
            "postal_code": "347474687",
            "telephone_number": "407-566-8505",
            "fax_number": "407-566-8253"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "JASON",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-01",
        "last_updated": "2017-11-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "FL",
            "license": "OPC4182",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Stephanie Janice Velazquez Rosado, M.D.
• Charles Verduzco, PHARMD
• Jill Suzanne Villarosa, PA-C
• Adria Vincent, DNP, RNC-OB, IBCLC
• Geoffrey C Waite, AU.D.
• Elizabeth Wallenquest, PT, DPT
• Amendha Ware, APRN
• Afraniq Warwick, M.S.ED, BCBA
• William T Watson III, DMD
• Dyan Louise Welch, ATC

• Optometrist in Celebration, FL
• Providers in Celebration, FL by specialty
• Optometrist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 8, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.