Active NPI
Andrew J Diaczyk, D.O.
- Optometrist
- St Petersburg, FL
National Provider Identifier
1902953433
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- OPC 1348
- Practice address
- 4887 34TH St S
St Petersburg, FL 33711-4509 - Phone
- (727) 864-4047
- Fax
- (727) 864-0060
- NPI assigned
- Jan 5, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | OPC 1348 | FL | Primary |
Addresses
Primary practice location
4887 34TH St S
St Petersburg, FL 33711-4509
Mailing address
4887 34TH St S
St Petersburg, FL 33711-4509
Phone (727) 864-4047
Medicare participation
Medicare enrollment files- 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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20120720000471 | FL | Practitioner - Optometry | 6507022498 | Practice locations: St Petersburg, FL |
Care Compare profile
Medicare Care Compare- Specialty
- Optometry
- Education
- Southern College of Optometry, 1976
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
4887 34TH St S
Saint Petersburg, FL 33711-4509
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| OPC 1348 | FL | MD | Optometrist |
Networks
- Freedom Health HMO Network
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1167955200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1902953433",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4887 34TH ST S",
"city": "ST PETERSBURG",
"state": "FL",
"postal_code": "337114509",
"telephone_number": "727-864-4047",
"fax_number": "727-864-0060"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4887 34TH ST S",
"city": "ST PETERSBURG",
"state": "FL",
"postal_code": "337114509",
"telephone_number": "727-864-4047",
"fax_number": "727-864-0060"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DIACZYK",
"first_name": "ANDREW",
"middle_name": "J",
"name_prefix": "Dr.",
"credential": "D.O.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-01-05",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "FL",
"license": "OPC 1348",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in St Petersburg, FL
- Harshini Dhananjay, DO
- Joseph Robindra Dhani, D.C.
- Claude Marguerite Dharamraj, M.D
- Bhumi Patel Dharia, D.M.D
- Mariana Di Cristo
- Diagnostic Chiropractic Mi PC
- Diagnostic Clinic Medical Group Inc
- Diagnostic Clinic Medical Group Inc
- Diagnostic Clinic Medical Group Inc.
- Diagnostic Clinic Medical Group Inc.
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.