Individual provider Active NPI

Joseph Gennaro Suriano, OD

  • Optometrist
  • Tampa, FL
National Provider Identifier
1922623461
Registry record updated Aug 19, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
046.011440 Issued in IL
Practice address
5709 Johns Rd Ste 1209
Tampa, FL 33634-4315
Phone
(813) 885-3937
NPI assigned
Jun 10, 2020
Last updated
Aug 19, 2020By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 19, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 046.011440 IL Primary

Addresses

Primary practice location

5709 Johns Rd Ste 1209
Tampa, FL 33634-4315

Mailing address

6121 River Bend Dr
Lisle, IL 60532-4510
Phone (630) 632-5072

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
I20200817000277 FL Practitioner - Optometry 3870919251 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Illinois College of Optometry at Chicago, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Eye Doctors Optical Outlets PAGroup PAC ID 0042123846, 97 clinicians

Practice addresses (Care Compare)

12950 E Colonial Dr
Suite 100
Orlando, FL 32826-4609
Phone (407) 658-9020

5020 E Colonial Dr
Orlando, FL 32803-4312
Phone (407) 895-6254

5607 Johns Rd
Tampa, FL 33634-4499
Phone (813) 385-1873

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
046.011440ILMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Eye Doctors Optical Outlets PA Optometrist CurrentSince Aug 23, 2020 Accepting new patients
Eye Doctors Optical Outlets PA Optometrist CurrentSince Aug 17, 2020 Accepting new patients
Eye Doctors Optical Outlets PA Optometrist CurrentSince Aug 17, 2020 Accepting new patients

Locations

12950 E Colonial Dr
Ste 100
Orlando, FL 32826
Phone (352) 361-5205

5020 E Colonial Dr
Orlando, FL 32803
Phone (321) 430-1266

5607 Johns Rd
Tampa, FL 33634
Phone (813) 385-1873

5709 Johns Rd
Ste 1209
Tampa, FL 33634
Phone (813) 885-3937

Networks

  • Freedom Health HMO Network

Organizations & group practices 3

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": "1591747200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1597795200000",
    "number": "1922623461",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6121 RIVER BEND DR",
            "city": "LISLE",
            "state": "IL",
            "postal_code": "605324510",
            "telephone_number": "630-632-5072"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5709 JOHNS RD STE 1209",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336344315",
            "telephone_number": "813-885-3937"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SURIANO",
        "first_name": "JOSEPH",
        "middle_name": "GENNARO",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-06-10",
        "last_updated": "2020-08-19",
        "certification_date": "2020-08-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "IL",
            "license": "046.011440",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tampa, FL

Sources for this page

Verify at the official NPI Registry.