Vassallo Eye Institute PA

Primary specialty

Ophthalmology PhysicianTaxonomy code 207W00000X

License

ME59092 Issued in FL

Legal business name

VASSALLO EYE INSTITUTE PA

Practice address

3780 US Highway 1 S
St Augustine, FL 32086-7150

Phone

(904) 797-7722

NPI assigned

Mar 4, 2008

Organization subpart

No

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

Authorized official

Name

John M Vassallo, MD

Title

Owner

Phone

(904) 797-7722

Specialties & licenses 1

Addresses

Other identifiers 3

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

{
    "created_epoch": "1204588800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1394582400000",
    "number": "1730359043",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1598",
            "city": "ST AUGUSTINE",
            "state": "FL",
            "postal_code": "320851598",
            "telephone_number": "904-797-7722"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3780 US HIGHWAY 1 S",
            "city": "ST AUGUSTINE",
            "state": "FL",
            "postal_code": "320867150",
            "telephone_number": "904-797-7722"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VASSALLO EYE INSTITUTE PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-03-04",
        "last_updated": "2014-03-12",
        "status": "A",
        "authorized_official_last_name": "VASSALLO",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "904-797-7722",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Ophthalmology",
            "state": "FL",
            "license": "ME59092",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "12416",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "006438501",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "006438500",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Clay Vandenberg, OTA
• Julie Marie Vandeusen, LCSW
• Ashley Baldwin Vanjaria, ARNP
• Arelis Angelina Vargas
• Elizabeth Winegeart Vargas
• John M Vassallo, MD
• Myralynn H Vaughn
• Stephanie Jean Vavilala, BCBA
• Francisco Q Vazquez
• Christine Laila Vega, RD

• Ophthalmology Physician in St Augustine, FL
• Providers in St Augustine, FL by specialty
• Ophthalmology Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 12, 2014; 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.