NPIMap

Organization Active NPI

Opticlub Express, Inc.

Doing business as Opticlub Express

  • Optometrist
  • Pace, FL
National Provider Identifier
1801381819
Registry record updated Dec 28, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
Legal business name
OPTICLUB EXPRESS, INC.
Doing business as
Opticlub Express
Practice address
4954 Highway 90
Pace, FL 32571-1413
Phone
(850) 910-4840
Fax
(850) 254-2970
NPI assigned
Jun 22, 2018
Last updated
Dec 28, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 28, 2019

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

Authorized official

Name
Dr. Andrew David Burtchell, ODNPI 1053862227
Title
President/Director
Phone
(850) 910-4840

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

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

Addresses

Primary practice location

4954 Highway 90
Pace, FL 32571-1413

Mailing address

4954 Highway 90
Pace, FL 32571-1413
Phone (850) 910-4840

Other names 1

  • Opticlub Express Doing business as

National Provider Directory

National Provider Directory

Locations

4954 Highway 90
Pace, FL 32571
Phone (850) 910-4840

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1529625600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1577491200000",
    "number": "1801381819",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4954 HIGHWAY 90",
            "city": "PACE",
            "state": "FL",
            "postal_code": "325711413",
            "telephone_number": "850-910-4840",
            "fax_number": "850-254-2970"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4954 HIGHWAY 90",
            "city": "PACE",
            "state": "FL",
            "postal_code": "325711413",
            "telephone_number": "850-910-4840",
            "fax_number": "850-254-2970"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OPTICLUB EXPRESS, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-06-22",
        "last_updated": "2019-12-28",
        "certification_date": "2019-12-28",
        "status": "A",
        "authorized_official_last_name": "BURTCHELL",
        "authorized_official_first_name": "ANDREW",
        "authorized_official_middle_name": "DAVID",
        "authorized_official_title_or_position": "PRESIDENT/DIRECTOR",
        "authorized_official_telephone_number": "850-910-4840",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Opticlub Express",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Pace, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 28, 2019; 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.