Individual provider Active NPI

Laurie S McConnell, OD PA

  • Optometrist
  • Tequesta, FL
National Provider Identifier
1912919994
Registry record updated Sep 29, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
OPC 3604 Issued in FL
Practice address
253 S US Highway 1
Tequesta, FL 33469-2701
Phone
(561) 746-5088
Fax
(561) 746-5984
NPI assigned
Aug 11, 2006
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 29, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X OPC 3604 FL Primary

Addresses

Primary practice location

253 S US Highway 1
Tequesta, FL 33469-2701

Mailing address

253 S US Highway 1
Tequesta, FL 33469-2701
Phone (561) 746-5088

Other identifiers 1

IdentifierTypeStateIssuer
621128300MedicaidFL

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
I20050412000279 FL Practitioner - Optometry 0840237988 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Other, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

253 US Hwy One
Tequesta, FL 33469-2701

253S US Hwy 1
Tequesta, FL 33469-2701
Phone (561) 746-5088

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
OPC 3604FLMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Laurie S McConnell OD PA Optometrist CurrentSince Nov 12, 2004 Accepting new patients

Locations

253 S US Highway 1
Tequesta, FL 33469
Phone (561) 746-5088

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1155254400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1222646400000",
    "number": "1912919994",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "253 S US HIGHWAY 1",
            "city": "TEQUESTA",
            "state": "FL",
            "postal_code": "334692701",
            "telephone_number": "561-746-5088",
            "fax_number": "561-746-5984"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "253 S US HIGHWAY 1",
            "city": "TEQUESTA",
            "state": "FL",
            "postal_code": "334692701",
            "telephone_number": "561-746-5088",
            "fax_number": "561-746-5984"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCCONNELL",
        "first_name": "LAURIE",
        "middle_name": "S",
        "credential": "OD PA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-08-11",
        "last_updated": "2008-09-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "FL",
            "license": "OPC 3604",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "621128300",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Tequesta, FL

Sources for this page

Verify at the official NPI Registry.