NPIMap

Organization Active NPI

Optimart, Inc.

Doing business as Optimart, Inc. #05

  • Optician
  • Seminole, FL
National Provider Identifier
1922215136
Registry record updated Oct 7, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
OpticianTaxonomy code 156FX1800X
License
OE379 Issued in FL
Legal business name
OPTIMART, INC.
Doing business as
Optimart, Inc. #05
Practice address
10755 Park Blvd
Seminole, FL 33772-5420
Phone
(727) 392-0907
Fax
(727) 592-2569
NPI assigned
May 17, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 7, 2021

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

Authorized official

Name
Gregory Louis Mathis
Title
Administrator
Phone
(727) 526-0501

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OpticianGroup: 193400000X SINGLE SPECIALTY GROUP 156FX1800X OE379 FL Primary

Addresses

Primary practice location

10755 Park Blvd
Seminole, FL 33772-5420

Mailing address

4359 35TH St N
Saint Petersburg, FL 33714-3717
Phone (727) 914-8615

Other identifiers 1

IdentifierTypeStateIssuer
630126600MedicaidFL

Other names 1

  • OPTIMART, INC. #05 Doing business as

National Provider Directory

National Provider Directory

Locations

13132 Cortez Blvd
Brooksville, FL 34613
Phone (352) 597-0410

1661 SE US Highway 19
Crystal River, FL 34429
Phone (352) 563-1666

461 S Indiana Ave
Englewood, FL 34223
Phone (941) 475-7784

35170 US Highway 19 N
Palm Harbor, FL 34684
Phone (727) 359-7603

33279 US Highway 19 N
Palm Harbor, FL 34684
Phone (727) 789-5333

8432 Lockwood Ridge Rd
Sarasota, FL 34243
Phone (941) 359-1105

7165 Seminole Blvd
Seminole, FL 33772
Phone (727) 392-0906

7165 Seminole Blvd
Ste A
Seminole, FL 33772
Phone (727) 392-0907

7330 Gall Blvd
Zephyrhills, FL 33541
Phone (813) 782-4546

Practitioners & affiliated clinicians

Practitioners 5

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": "1179360000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1633564800000",
    "number": "1922215136",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4359 35TH ST N",
            "city": "SAINT PETERSBURG",
            "state": "FL",
            "postal_code": "337143717",
            "telephone_number": "727-914-8615",
            "fax_number": "727-914-8610"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10755 PARK BLVD",
            "city": "SEMINOLE",
            "state": "FL",
            "postal_code": "337725420",
            "telephone_number": "727-392-0907",
            "fax_number": "727-592-2569"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OPTIMART, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-17",
        "last_updated": "2021-10-07",
        "certification_date": "2021-10-07",
        "status": "A",
        "authorized_official_last_name": "MATHIS",
        "authorized_official_first_name": "GREGORY",
        "authorized_official_middle_name": "LOUIS",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "727-526-0501"
    },
    "taxonomies": [
        {
            "code": "156FX1800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Technician/Technologist, Optician",
            "state": "FL",
            "license": "OE379",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "630126600",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "OPTIMART, INC. #05",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "OPTIMART, INC. #05",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Seminole, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 7, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.