Marie Lauretta Seide-Justin, O.D. – Optometrist

Key facts

NPI: 1760423271
Entity type: Individual (NPI type 1)
Primary specialty: Optometrist 152W00000X
License: OPC003955 (FL)
Practice address: 6601 Old Winter Garden Rd
Unit 104
Orlando, FL 32835-1370
Phone: (407) 292-9812
Fax: (407) 292-9813
NPI assigned: Jun 8, 2006
Sex: Female
Sole proprietor: Yes

Organizations & group practices 2

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.

Millennium Eye Center, Inc. Optometrist · Orlando, FL · NPI 1790721652

Medicare reassignment NPD Authorized official FL · OPTOMETRIST
3D Vision Eye Surgery Center Ophthalmology Physician · Daytona Beach, FL · NPI 1245569508

NPD (past)

Medicare Care Compare profile

Specialty: Optometry
Education: New England College of Optometry, 2002
Medicare assignment: Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

1515 Park Ctr Dr
Suite 2H
Orlando, FL 32835-5794
Phone (407) 292-9812

Medicare participation

Medicare fee-for-service enrollment: Enrolled in FL
Eligible to order & refer: Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes

Medicare enrollment records

Enrollment ID	State	Provider type	PAC ID	Details
I20070413000481	FL	Practitioner - Optometry	2466557814	Reassigns benefits to 1 organization

National Provider Directory

Medicare enrollment (NPD): Yes

Practice roles

Organization	Specialty	Status	New patients
Millennium Eye Center, Inc.	Optometrist	Current since Sep 22, 2006	Accepting new patients
3D Vision Eye Surgery Center		Past since Sep 22, 2006	Accepting new patients

Locations

1515 Park Center Dr
Ste 2H
Orlando, FL 32835
Phone (407) 308-1935

6601 Old Winter Garden Rd
Ste 104
Orlando, FL 32835
Phone (407) 292-9812

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Optometrist	152W00000X	OPC003955	FL	Yes

Addresses

Primary practice location

6601 Old Winter Garden Rd
Unit 104
Orlando, FL 32835-1370

Mailing address

6601 Old Winter Garden Rd
Snit 104
Orlando, FL 32835-1370
Phone (407) 292-9812

Other identifiers

Identifier	Type	State	Issuer
621147000	Medicaid	FL

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jun 22, 2011.

{
    "created_epoch": "1149724800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1308700800000",
    "number": "1760423271",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6601 OLD WINTER GARDEN RD",
            "address_2": "SNIT 104",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328351370",
            "telephone_number": "407-292-9812",
            "fax_number": "407-292-9813"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6601 OLD WINTER GARDEN RD",
            "address_2": "UNIT 104",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328351370",
            "telephone_number": "407-292-9812",
            "fax_number": "407-292-9813"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SEIDE-JUSTIN",
        "first_name": "MARIE",
        "middle_name": "LAURETTA",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-06-08",
        "last_updated": "2011-06-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "FL",
            "license": "OPC003955",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "621147000",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Orlando, FL

All providers in Orlando, FL · Optometrist in Florida

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 22, 2011. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
Order and Referring (CMS).
Medicare Care Compare provider data (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.