Eastgate Vision Center

Primary specialty

OpticianTaxonomy code 156FX1800X

License

D01128 Issued in FL

Legal business name

EASTGATE VISION CENTER

Practice address

164 Hwy 17 South
Suite 12-C Eastgate Vision Center
East Palatka, FL 32131

Phone

(386) 328-2008

Fax

(386) 328-2008

NPI assigned

Mar 19, 2008

Last updated

Sep 24, 2010By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mrs. Marsha Lynn Roach, OPTICIAN

Title

Optician

Phone

(386) 328-2008

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1205884800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1285286400000",
    "number": "1689845471",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "164 HWY 17 SOUTH",
            "address_2": "SUITE 12-C",
            "city": "EAST PALATKA",
            "state": "FL",
            "postal_code": "32131",
            "telephone_number": "386-328-2008",
            "fax_number": "386-328-2008"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "164 HWY 17 SOUTH",
            "address_2": "SUITE 12-C EASTGATE VISION CENTER",
            "city": "EAST PALATKA",
            "state": "FL",
            "postal_code": "32131",
            "telephone_number": "386-328-2008",
            "fax_number": "386-328-2008"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EASTGATE VISION CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-03-19",
        "last_updated": "2010-09-24",
        "status": "A",
        "authorized_official_last_name": "ROACH",
        "authorized_official_first_name": "MARSHA",
        "authorized_official_middle_name": "LYNN",
        "authorized_official_title_or_position": "OPTICIAN",
        "authorized_official_telephone_number": "386-328-2008",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "OPTICIAN"
    },
    "taxonomies": [
        {
            "code": "156FX1800X",
            "taxonomy_group": "",
            "desc": "Technician/Technologist, Optician",
            "state": "FL",
            "license": "D01128",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Optician in East Palatka, FL
• Providers in East Palatka, FL by specialty
• Optician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 24, 2010; 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.