Individual provider Active NPI

Sam Harris Schwartz

  • Optometrist
  • St Petersburg, FL
National Provider Identifier
1912752163
Registry record updated Sep 27, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
OPC6521 Issued in FL
Practice address
1350 4TH St N
St Petersburg, FL 33701-1118
Phone
(727) 498-5117
NPI assigned
Apr 22, 2024
Last updated
Sep 27, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 27, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X OPC6521 FL Primary

Addresses

Primary practice location

1350 4TH St N
St Petersburg, FL 33701-1118

Mailing address

1192 Camellia Cir
Weston, FL 33326-3609
Phone (954) 614-5396

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240722003900 FL Practitioner - Optometry 8729524152 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
OPC6521FLMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Pearle Capstone Eye Associates PLLC Optometrist CurrentSince Sep 29, 2024 Accepting new patients
Pearle Capstone Eye Associates, PLLC Optometrist CurrentSince Jul 10, 2024 Accepting new patients

Locations

13555 Highway 54
Ste C
Odessa, FL 33556
Phone (813) 454-0670

1350 4th St N
St Petersburg, FL 33701
Phone (727) 498-5117

1601 NW Expressway
Ste 1420
Oklahoma City, OK 73118

Networks

  • Freedom Health HMO Network

Organizations & group practices 2

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

NPI Registry JSON

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

{
    "created_epoch": "1713744000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1727395200000",
    "number": "1912752163",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1192 CAMELLIA CIR",
            "city": "WESTON",
            "state": "FL",
            "postal_code": "333263609",
            "telephone_number": "954-614-5396"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1350 4TH ST N",
            "city": "ST PETERSBURG",
            "state": "FL",
            "postal_code": "337011118",
            "telephone_number": "727-498-5117"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SCHWARTZ",
        "first_name": "SAM",
        "middle_name": "HARRIS",
        "name_prefix": "Mr.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-04-22",
        "last_updated": "2024-09-27",
        "certification_date": "2024-09-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "FL",
            "license": "OPC6521",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in St Petersburg, FL

Sources for this page

Verify at the official NPI Registry.