Individual provider Active NPI

Dominic James Pastore, O.D.

  • Optometrist
  • Melbourne, FL
National Provider Identifier
1720025711
Registry record updated Oct 27, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
OPC 3723 Issued in FL
Practice address
1000 N Wickham Rd
Melbourne, FL 32935-8937
Phone
(321) 259-1699
Fax
(321) 259-4658
NPI assigned
May 31, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 27, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X OPC 3723 FL Primary

Addresses

Primary practice location

1000 N Wickham Rd
Melbourne, FL 32935-8937

Mailing address

PO Box 560580
Rockledge, FL 32956-0580
Phone (321) 693-1534

Other identifiers 2

IdentifierTypeStateIssuer
20680OtherFLBCBS OF FL
620836300MedicaidFL

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20101019001231 FL Practitioner - Optometry 7719170026 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Other, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Pastore-Tran Eyecare, Inc.Group PAC ID 6103897277, 2 clinicians

Practice addresses (Care Compare)

1000 N Wickham Rd
Melbourne, FL 32935-8937
Phone (321) 259-1699

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
OPC 3723FLMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Pastore-Tran Eyecare, Inc. Optometrist CurrentSince Jan 1, 2010 Accepting new patients

Locations

5500 Stadium Pkwy
Ste 102
Melbourne, FL 32940
Phone (321) 639-2020

1000 N Wickham Rd
Melbourne, FL 32935
Phone (321) 242-6037

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1149033600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1288137600000",
    "number": "1720025711",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 560580",
            "city": "ROCKLEDGE",
            "state": "FL",
            "postal_code": "329560580",
            "telephone_number": "321-693-1534",
            "fax_number": "321-259-4658"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 N WICKHAM RD",
            "city": "MELBOURNE",
            "state": "FL",
            "postal_code": "329358937",
            "telephone_number": "321-259-1699",
            "fax_number": "321-259-4658"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PASTORE",
        "first_name": "DOMINIC",
        "middle_name": "JAMES",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-31",
        "last_updated": "2010-10-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "FL",
            "license": "OPC 3723",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF FL",
            "identifier": "20680",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "620836300",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Melbourne, FL

Sources for this page

Verify at the official NPI Registry.