Jay Richard Harrelson, O.D

Primary specialty

OptometristTaxonomy code 152W00000X

License

OPC5223 Issued in FL

Practice address

13245 Atlantic Blvd Ste 8
Jacksonville, FL 32225-7118

Phone

(904) 477-4379

Fax

(904) 647-7926

NPI assigned

Jun 7, 2016

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

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

Nova Southeastern Univ College of Dental Medicine, 2016

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Gateway Vision IncGroup PAC ID 8022029222, 5 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.

• Gateway Vision Inc

  • Optometrist
  • Atlantic Beach, FL
  • NPI 1205885886
  Medicare reassignment Care Compare group NPD
• Harrelson Eye LLC

  • Optometrist
  • Jacksonville, FL
  • NPI 1790393080
  Medicare reassignment Authorized official

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

{
    "created_epoch": "1465257600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1578268800000",
    "number": "1700235173",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13245 ATLANTIC BLVD STE 8",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322257118",
            "telephone_number": "904-477-4379",
            "fax_number": "904-647-7926"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13245 ATLANTIC BLVD STE 8",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322257118",
            "telephone_number": "904-477-4379",
            "fax_number": "904-647-7926"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HARRELSON",
        "first_name": "JAY",
        "middle_name": "RICHARD",
        "credential": "O.D",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2016-06-07",
        "last_updated": "2020-01-06",
        "certification_date": "2020-01-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "FL",
            "license": "OPC5223",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "10114960",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Lauren Michelle Harrell, ARNP
• Marcelle Genis Harrell, APRN
• Melanie Rose Harrell, PA-C
• Randell Glenn Harrell
• Harrelson Eye LLC
• Leeann Harridsleff
• Harrington Partners LLC
• Asionna Harrington-Killila
• Jessie Carson Harrington, CF-SLP
• Nicolas Harrington

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 6, 2020; 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.