Active NPI
Bao Phan
- Optometrist
- Sanford, FL
National Provider Identifier
1982019618
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- OPC 4911
- Practice address
- 2053 WP Ball Blvd
Sanford, FL 32771 - Phone
- (407) 322-9176
- NPI assigned
- Jun 20, 2014
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | OPC 4911 | FL | Primary |
Addresses
Primary practice location
2053 WP Ball Blvd
Sanford, FL 32771
Mailing address
2053 WP Ball Blvd
Sanford, FL 32771
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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20140911000750 | FL | Practitioner - Optometry | 2567681273 | Reassigns benefits to 1 organization |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| OPC 4911 | FL | MD | Optometrist |
Practice roles (4 of 5)
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Eye Doctors Optical Outlets PA | Optometrist | Current | Accepting new patients |
| Eye Doctors Optical Outlets PA | Optometrist | Current | Accepting new patients |
| Phan-Tastic Eye Care LLC | Optometrist | Current | Accepting new patients |
| America'S Best Contacts & Eyeglasses | Past | Accepting new patients |
Locations
5607 Johns Rd
Tampa, FL 33634
Phone (813) 385-1873
Networks
- Freedom Health HMO Network
Organizations & group practices 4
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.
-
- Optometrist
- Oviedo, FL
- NPI 1841151925
-
- Optometrist
- Tampa, FL
- NPI 1114012689
-
- Optician
- Sanford, FL
- NPI 1235409871
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1403222400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1403222400000",
"number": "1982019618",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2053 WP BALL BLVD",
"city": "SANFORD",
"state": "FL",
"postal_code": "32771"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2053 WP BALL BLVD",
"city": "SANFORD",
"state": "FL",
"postal_code": "32771",
"telephone_number": "407-322-9176"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PHAN",
"first_name": "BAO",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2014-06-20",
"last_updated": "2014-06-20",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "FL",
"license": "OPC 4911",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Sanford, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.