Low Vision of Panama City LLC

Primary specialty

Low Vision Rehabilitation OptometristTaxonomy code 152WL0500X

License

OPC5212 Issued in FL

Legal business name

LOW VISION OF PANAMA CITY LLC

Practice address

826 Harrison Ave
Panama City, FL 32401-2526

Phone

(850) 769-1404

Fax

(850) 769-0748

NPI assigned

Jul 14, 2016

Last updated

Jul 14, 2016By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Stephanie Quesada Moore, OD

Title

Owner

Phone

(850) 769-1404

Specialties & licenses 2

Addresses

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

{
    "created_epoch": "1468454400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1468454400000",
    "number": "1881047850",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "826 HARRISON AVE",
            "city": "PANAMA CITY",
            "state": "FL",
            "postal_code": "324012526",
            "telephone_number": "850-769-1404",
            "fax_number": "850-769-0748"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "826 HARRISON AVE",
            "city": "PANAMA CITY",
            "state": "FL",
            "postal_code": "324012526",
            "telephone_number": "850-769-1404",
            "fax_number": "850-769-0748"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LOW VISION OF PANAMA CITY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-07-14",
        "last_updated": "2016-07-14",
        "status": "A",
        "authorized_official_last_name": "QUESADA MOORE",
        "authorized_official_first_name": "STEPHANIE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "850-769-1404",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "FL",
            "license": "OPC5212",
            "primary": false
        },
        {
            "code": "152WL0500X",
            "taxonomy_group": "",
            "desc": "Optometrist, Low Vision Rehabilitation",
            "state": "FL",
            "license": "OPC5212",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Low Vision Rehabilitation Optometrist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 14, 2016; 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.