Active NPI
Walter Lee Ball Jr., OD
- Optometrist
- Jacksonville, FL
National Provider Identifier
1811997752
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- OPC3639
- Practice address
- 7500 Centurion Parkway
Suite 100 Dacaf
Jacksonville, FL 32256-0517 - Phone
- (904) 443-1383
- Fax
- (904) 928-5805
- NPI assigned
- Jul 21, 2005
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 4348 | MA | |
| Optometrist | 152W00000X | OPC3639 | FL | Primary |
| Optometrist | 152W00000X | 2141 | NC |
Addresses
Primary practice location
7500 Centurion Parkway
Suite 100 Dacaf
Jacksonville, FL 32256-0517
Mailing address
7500 Centurion Parkway
Suite 100 Dacaf
Jacksonville, FL 32256-0517
Phone (904) 443-1383
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0323471 | Medicaid | MA |
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2141 | NC | MD | Addiction (Substance Use Disorder) Counselor |
| OPC3639 | FL | MD | Optometrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1121904000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1334275200000",
"number": "1811997752",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7500 CENTURION PARKWAY",
"address_2": "SUITE 100 DACAF",
"city": "JACKSONVILLE",
"state": "FL",
"postal_code": "322560517",
"telephone_number": "904-443-1383",
"fax_number": "904-928-5805"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7500 CENTURION PARKWAY",
"address_2": "SUITE 100 DACAF",
"city": "JACKSONVILLE",
"state": "FL",
"postal_code": "322560517",
"telephone_number": "904-443-1383",
"fax_number": "904-928-5805"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BALL",
"first_name": "WALTER",
"middle_name": "LEE",
"name_prefix": "Dr.",
"name_suffix": "Jr.",
"credential": "OD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2005-07-21",
"last_updated": "2012-04-13",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "MA",
"license": "4348",
"primary": false
},
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "FL",
"license": "OPC3639",
"primary": true
},
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "NC",
"license": "2141",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0323471",
"state": "MA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Jacksonville, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 13, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.