St Johns Eye Care P a

Primary specialty

OptometristTaxonomy code 152W00000X

License

20061021 Issued in FL

Legal business name

ST JOHNS EYE CARE P A

Practice address

2504 Crill Ave
Palatka, FL 32177-4264

Phone

(386) 328-5141

Fax

(386) 328-3972

NPI assigned

Jan 26, 2007

Organization subpart

No

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

Authorized official

Name

Dr. John M Lennon, O.DNPI 1104800697

Title

President

Phone

(386) 328-5141

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Locations

Practitioners 1

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

• John M Lennon Jr., OD

  • Optometrist
  • Palatka, FL
  • NPI 1104800697
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1169769600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1720483200000",
    "number": "1912053547",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2504 CRILL AVE",
            "city": "PALATKA",
            "state": "FL",
            "postal_code": "321774264",
            "telephone_number": "386-328-5141",
            "fax_number": "386-328-3972"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2504 CRILL AVE",
            "city": "PALATKA",
            "state": "FL",
            "postal_code": "321774264",
            "telephone_number": "386-328-5141",
            "fax_number": "386-328-3972"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST JOHNS EYE CARE P A",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-26",
        "last_updated": "2024-07-09",
        "certification_date": "2024-07-09",
        "status": "A",
        "authorized_official_last_name": "LENNON",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "386-328-5141",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "FL",
            "license": "20061021",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "122939400",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sodang Daniel Sou, PHARMACIST
• Southern Therapies of North Florida
• Southern Therapies of North Florida Inc
• Brian J Sprenger, ARNP
• St Augustine Physicians Associates, Inc.
• St. Augustine Physician Associates, Inc
• St. Johns River Dental
• Logan Stallings
• Jennifer Dye Standridge, ARNP
• Kelly Starr, LMT

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2024; 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.