Jacklyn Ly, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

OPC6845 Issued in FL

Practice address

11794 E Colonial Dr
Orlando, FL 32817-4626

Phone

(407) 904-4431

NPI assigned

Sep 29, 2025

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, 2025

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Aeg Florida Professional PLLCGroup PAC ID 3870960032, 70 clinicians

Practice addresses (Care Compare)

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.

• Aeg Florida Professional PLLC

  • Optometrist
  • Jacksonville, FL
  • NPI 1164156246
  Medicare reassignment Care Compare group NPD
• Eye Associates of Mid Florida, P.a.

  • Optometrist
  • Orlando, FL
  • NPI 1902359003
  NPD

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

{
    "created_epoch": "1759104000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1768867200000",
    "number": "1902779465",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11794 E COLONIAL DR",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328174626",
            "telephone_number": "407-904-4431"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11794 E COLONIAL DR",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328174626",
            "telephone_number": "407-904-4431"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LY",
        "first_name": "JACKLYN",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-09-29",
        "last_updated": "2026-01-20",
        "certification_date": "2026-01-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "FL",
            "license": "OPC6845",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Luxottica Retail North America Inc (Sears Optical #C0118)
• Luxottica Retail North America Inc (Target Optical #C4224)
• Jessica Luzincourt, BSW, CNP
• LW Peds PT, LLC
• Khine Su Lwin, M.D.
• Phuong Ly
• Kelsea Lydon, PA-C
• Lyfe Changes LLC (James J Young)
• Morgan Leeann Lyles, DNAP
• Kacy D Lyman, CRNA

• Optometrist in Orlando, FL
• Providers in Orlando, FL by specialty
• Optometrist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 20, 2026; 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.