Optical Retail Associates, LLC

Primary specialty

OptometristTaxonomy code 152W00000X

Legal business name

OPTICAL RETAIL ASSOCIATES, LLC

Doing business as

Northwest Florida Vision Center

Practice address

5113 N Davis Hwy
Suite 11
Pensacola, FL 32503-2035

Phone

(850) 549-3450

Fax

(850) 497-6219

NPI assigned

May 12, 2011

Organization subpart

No

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

Authorized official

Name

Mr. Carl H Spear, OD

Title

Owner/Optometrist

Phone

(850) 549-3450

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Northwest Florida Vision Center Doing business as

Locations

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

{
    "created_epoch": "1305158400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1418947200000",
    "number": "1841582525",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5113 N DAVIS HWY",
            "address_2": "SUITE 11",
            "city": "PENSACOLA",
            "state": "FL",
            "postal_code": "325032035",
            "telephone_number": "850-549-3450",
            "fax_number": "850-497-6219"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5113 N DAVIS HWY",
            "address_2": "SUITE 11",
            "city": "PENSACOLA",
            "state": "FL",
            "postal_code": "325032035",
            "telephone_number": "850-549-3450",
            "fax_number": "850-497-6219"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OPTICAL RETAIL ASSOCIATES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-05-12",
        "last_updated": "2014-12-19",
        "status": "A",
        "authorized_official_last_name": "SPEAR",
        "authorized_official_first_name": "CARL",
        "authorized_official_middle_name": "H",
        "authorized_official_title_or_position": "OWNER/OPTOMETRIST",
        "authorized_official_telephone_number": "850-549-3450",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003669300",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Northwest Florida Vision Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 19, 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.