Active NPI
Stacey Elizabeth Illikal, OD
- Optometrist
- St Petersburg, FL
National Provider Identifier
1780257626
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- OPC5958
- Practice address
- 3301 4TH St N
St Petersburg, FL 33704-1305 - Phone
- (727) 821-9540
- Fax
- (727) 823-1487
- NPI assigned
- Jul 19, 2021
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | OPC5958 | FL | Primary |
Addresses
Primary practice location
3301 4TH St N
St Petersburg, FL 33704-1305
Mailing address
4112 Imperial Eagle Dr
Valrico, FL 33594-3965
Phone (813) 545-1708
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| National Vision, Inc. | Past | Accepting new patients | |
| National Vision, Inc. | Past | Accepting new patients |
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1626652800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1626652800000",
"number": "1780257626",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4112 IMPERIAL EAGLE DR",
"city": "VALRICO",
"state": "FL",
"postal_code": "335943965",
"telephone_number": "813-545-1708"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3301 4TH ST N",
"city": "ST PETERSBURG",
"state": "FL",
"postal_code": "337041305",
"telephone_number": "727-821-9540",
"fax_number": "727-823-1487"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ILLIKAL",
"first_name": "STACEY",
"middle_name": "ELIZABETH",
"name_prefix": "Dr.",
"credential": "OD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2021-07-19",
"last_updated": "2021-07-19",
"certification_date": "2021-07-19",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "FL",
"license": "OPC5958",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in St Petersburg, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 19, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.