NPIMap

Organization Active NPI

KDJ Enterprises, LLC

  • Optometrist
  • Gainesville, FL
National Provider Identifier
1700378445
Registry record updated May 30, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
Legal business name
KDJ ENTERPRISES, LLC
Practice address
3321 SW Archer Rd
Gainesville, FL 32608-1745
Phone
(561) 275-2020
NPI assigned
May 30, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 30, 2018

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

Authorized official

Name
Jackie Bennett
Title
Credentialing Specialist
Phone
(561) 433-6009

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X Primary

Addresses

Primary practice location

3321 SW Archer Rd
Gainesville, FL 32608-1745

Mailing address

3321 SW Archer Rd
Gainesville, FL 32608-1745
Phone (561) 275-2020

Other names 1

  • My Eye Lab Doing business as

National Provider Directory

National Provider Directory
Tax ID family
KDJ Enterprises LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1527638400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1527638400000",
    "number": "1700378445",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3321 SW ARCHER RD",
            "city": "GAINESVILLE",
            "state": "FL",
            "postal_code": "326081745",
            "telephone_number": "561-275-2020"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3321 SW ARCHER RD",
            "city": "GAINESVILLE",
            "state": "FL",
            "postal_code": "326081745",
            "telephone_number": "561-275-2020"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KDJ ENTERPRISES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-05-30",
        "last_updated": "2018-05-30",
        "status": "A",
        "authorized_official_last_name": "BENNETT",
        "authorized_official_first_name": "JACKIE",
        "authorized_official_title_or_position": "CREDENTIALING SPECIALIST",
        "authorized_official_telephone_number": "561-433-6009"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "My Eye Lab",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "My Eye Lab",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Gainesville, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 30, 2018; 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.