Kelly Jacobi Waddell, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

OPC4270 Issued in FL

Practice address

2305 Oleander Ave.
Fort Pierce, FL 34982

Phone

(772) 465-6616

Fax

(772) 468-2858

NPI assigned

Sep 10, 2007

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Optometry

Education

Other, 2007

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

J.S. Davis LLCGroup PAC ID 4385902006, 4 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• J.S. Davis L.L.C.

  • Optometrist
  • Palm City, FL
  • NPI 1568977841
  Medicare reassignment Care Compare group NPD
• Stephen B Allison

  • Eyewear Supplier
  • Palm City, FL
  • NPI 1174792931

  Optometrist

  NPD (past)

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

{
    "created_epoch": "1189382400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1248652800000",
    "number": "1881889251",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2305 OLEANDER AVE.",
            "city": "FORT PIERCE",
            "state": "FL",
            "postal_code": "34982",
            "telephone_number": "772-465-6616",
            "fax_number": "772-468-2858"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2305 OLEANDER AVE.",
            "city": "FORT PIERCE",
            "state": "FL",
            "postal_code": "34982",
            "telephone_number": "772-465-6616",
            "fax_number": "772-468-2858"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WADDELL",
        "first_name": "KELLY",
        "middle_name": "JACOBI",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-09-10",
        "last_updated": "2009-07-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "FL",
            "license": "OPC4270",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Matthew Voelker
• Erika Vrooman
• Trisha Vuong, MD
• Vym@X
• W.Roger Long DDS.,P.a.
• Kristin Waddell
• Theresa D Wade
• Wal-Mart Stores East LP
• Wal-Mart Stores East, LP
• Walgreen Co

• Optometrist in Fort Pierce, FL
• Providers in Fort Pierce, FL by specialty
• Optometrist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 27, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.