Individual provider Active NPI

Joanna Madonna Kluesner, OD

  • Optometrist
  • Port Charlotte, FL
National Provider Identifier
1952909855
Registry record updated Jan 7, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
OPC5874 Issued in FL
Practice address
701 J C Center CT Unit 18
Port Charlotte, FL 33954-2826
Phone
(941) 624-3939
NPI assigned
Oct 13, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 7, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X OPC5874 FL Primary

Addresses

Primary practice location

701 J C Center CT Unit 18
Port Charlotte, FL 33954-2826

Mailing address

701 J C Center CT Unit 18
Port Charlotte, FL 33954-2826
Phone (941) 624-3939

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
I20201118001684 FL Practitioner - Optometry 0345651618 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Full Spectrum Family Vision Care PA Current Accepting new patients
Rhiannon L. Maggiore, O.D, P.a. Optometrist CurrentSince Sep 5, 2024 Accepting new patients
Full Spectrum Family Vision Care PA Optometrist CurrentSince Oct 19, 2020 Accepting new patients

Locations

217 Del Prado Blvd S
Ste 101
Cape Coral, FL 33990
Phone (239) 573-3937

701 J C Center Ct
Unit 18
Pt Charlotte, FL 33954
Phone (941) 204-4260

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1602547200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1736208000000",
    "number": "1952909855",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "701 J C CENTER CT UNIT 18",
            "city": "PORT CHARLOTTE",
            "state": "FL",
            "postal_code": "339542826",
            "telephone_number": "941-624-3939",
            "fax_number": "941-624-3949"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "701 J C CENTER CT UNIT 18",
            "city": "PORT CHARLOTTE",
            "state": "FL",
            "postal_code": "339542826",
            "telephone_number": "941-624-3939"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KLUESNER",
        "first_name": "JOANNA",
        "middle_name": "MADONNA",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-10-13",
        "last_updated": "2025-01-07",
        "certification_date": "2025-01-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "FL",
            "license": "OPC5874",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Port Charlotte, FL

Sources for this page

Verify at the official NPI Registry.