Organization Active NPI

Michael Holifield OD PA

Doing business as Central Park Vision Center

  • Optometrist
  • Plantation, FL
National Provider Identifier
1902947690
Registry record updated Oct 18, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
FL 3238 Issued in FL
Legal business name
MICHAEL HOLIFIELD OD PA
Doing business as
Central Park Vision Center
Practice address
9711 W Broward Blvd
Plantation, FL 33324-2309
Phone
(954) 474-1374
NPI assigned
Feb 8, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 18, 2012

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

Authorized official

Name
Dr. Michael Holifield, O.D.NPI 1679731681
Title
Optometrist President
Phone
(954) 474-1374

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X FL 3238 FL Primary

Addresses

Primary practice location

9711 W Broward Blvd
Plantation, FL 33324-2309

Mailing address

9711 W Broward Blvd
Plantation, FL 33324-2309
Phone (954) 474-1374

Other identifiers 1

IdentifierTypeStateIssuer
620824000MedicaidFL

Other names 1

  • Central Park Vision Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20121112000014 FL Part B Supplier - Clinic/Group Practice 6305097858 Receives reassigned benefits from 1 practitioner
Practice locations: Plantation, FL

National Provider Directory

National Provider Directory

Locations

9711 W Broward Blvd
Plantation, FL 33324
Phone (954) 474-1374

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1170892800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1350518400000",
    "number": "1902947690",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9711 W BROWARD BLVD",
            "city": "PLANTATION",
            "state": "FL",
            "postal_code": "333242309",
            "telephone_number": "954-474-1374"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9711 W BROWARD BLVD",
            "city": "PLANTATION",
            "state": "FL",
            "postal_code": "333242309",
            "telephone_number": "954-474-1374"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MICHAEL HOLIFIELD OD PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-08",
        "last_updated": "2012-10-18",
        "status": "A",
        "authorized_official_last_name": "HOLIFIELD",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "OPTOMETRIST  PRESIDENT",
        "authorized_official_telephone_number": "954-474-1374",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "FL",
            "license": "FL 3238",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "620824000",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Central Park Vision Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Plantation, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.