NPIMap

Organization Active NPI

Optimart, Inc.

  • Optician
  • Ruskin, FL
National Provider Identifier
1861600488
Registry record updated Jul 1, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
OpticianTaxonomy code 156FX1800X
License
OE368 Issued in FL
Legal business name
OPTIMART, INC.
Practice address
3830 Sun City Center Blvd Ste 105
Ruskin, FL 33573-6820
Phone
(813) 634-6155
Fax
(813) 634-6236
NPI assigned
May 18, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 1, 2020

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

Authorized official

Name
Gregory Louis Mathis
Title
Administrator
Phone
(727) 914-8615

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OpticianGroup: 193400000X SINGLE SPECIALTY GROUP 156FX1800X OE368 FL Primary

Addresses

Primary practice location

3830 Sun City Center Blvd Ste 105
Ruskin, FL 33573-6820

Mailing address

4359 35TH St N
St Petersburg, FL 33714-3717
Phone (727) 914-8615

Other identifiers 1

IdentifierTypeStateIssuer
630126600MedicaidFL

Other names 1

  • OPTIMART, INC. #01 Doing business as

National Provider Directory

National Provider Directory

Locations

3830 Sun City Center Blvd
Ste 105
Sun City Center, FL 33573
Phone (813) 634-6155

NPI Registry JSON

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

{
    "created_epoch": "1179446400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1593561600000",
    "number": "1861600488",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4359 35TH ST N",
            "city": "ST PETERSBURG",
            "state": "FL",
            "postal_code": "337143717",
            "telephone_number": "727-914-8615",
            "fax_number": "727-914-8610"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3830 SUN CITY CENTER BLVD STE 105",
            "city": "RUSKIN",
            "state": "FL",
            "postal_code": "335736820",
            "telephone_number": "813-634-6155",
            "fax_number": "813-634-6236"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OPTIMART, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-18",
        "last_updated": "2020-07-01",
        "certification_date": "2020-07-01",
        "status": "A",
        "authorized_official_last_name": "MATHIS",
        "authorized_official_first_name": "GREGORY",
        "authorized_official_middle_name": "LOUIS",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "727-914-8615"
    },
    "taxonomies": [
        {
            "code": "156FX1800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Technician/Technologist, Optician",
            "state": "FL",
            "license": "OE368",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "630126600",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "OPTIMART, INC. #01",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "OPTIMART, INC. #01",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Ruskin, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 1, 2020; 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.