Individual provider Active NPI

Michelle Nhu Quynh Nguyen, OD

  • Optometrist
  • St Petersburg, FL
National Provider Identifier
1982272423
Registry record updated Jun 28, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
OPC005942 Issued in FL
Practice address
2109 66TH St N
St Petersburg, FL 33710-4711
Phone
(727) 342-5226
NPI assigned
Jun 11, 2021
Last updated
Jun 28, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 28, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X FL
Optometrist 152W00000X OPC005942 FL Primary

Addresses

Primary practice location

2109 66TH St N
St Petersburg, FL 33710-4711

Mailing address

2109 66TH St N
St Petersburg, FL 33710-4711
Phone (727) 342-5226

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
I20210804002484 FL Practitioner - Optometry 2961806591 Reassigns benefits to 3 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
OPC005942FLMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Gulf Coast Optometry, PA CurrentSince Jul 12, 2021 Accepting new patients
Dr. Claffie and Associates, O.D., P.a. Optometrist CurrentSince Jan 18, 2022 Accepting new patients
Pearle Capstone Eye Associates, PLLC Optometrist CurrentSince Jun 29, 2023 Accepting new patients
National Vision, Inc. Past Accepting new patients
Eyeglass World PastSince Jun 15, 2021 Accepting new patients
National Vision, Inc. Past Accepting new patients

Locations

706 W State Road 436
Altamonte Springs, FL 32714
Phone (407) 774-1318

4957 S Cleveland Ave
Fort Myers, FL 33907
Phone (239) 278-1217

2411 SW College Rd
Ocala, FL 34471
Phone (352) 873-3937

13555 Highway 54
Ste C
Odessa, FL 33556
Phone (813) 454-0670

2109 66th St N
St Petersburg, FL 33710
Phone (727) 342-5226

1725 W Mlk Blvd
Tampa, FL 33607
Phone (239) 800-1717

2223 N West Shore Blvd
Ste 202
Tampa, FL 33607
Phone (813) 350-0870

1601 NW Expressway
Ste 1420
Oklahoma City, OK 73118

Organizations & group practices 6

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": "1623369600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1624838400000",
    "number": "1982272423",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2109 66TH ST N",
            "city": "ST PETERSBURG",
            "state": "FL",
            "postal_code": "337104711",
            "telephone_number": "727-342-5226"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2109 66TH ST N",
            "city": "ST PETERSBURG",
            "state": "FL",
            "postal_code": "337104711",
            "telephone_number": "727-342-5226"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NGUYEN",
        "first_name": "MICHELLE",
        "middle_name": "NHU QUYNH",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-06-11",
        "last_updated": "2021-06-28",
        "certification_date": "2021-06-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "FL",
            "license": null,
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "FL",
            "license": "OPC005942",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in St Petersburg, FL

Sources for this page

Verify at the official NPI Registry.