Florida Eye Specialists PA

Primary specialty

Ophthalmology PhysicianTaxonomy code 207W00000X

License

ME84552 Issued in FL

Legal business name

FLORIDA EYE SPECIALISTS PA

Practice address

11512 Lake Mead Ave
Suite 534
Jacksonville, FL 32256-9680

Phone

(904) 382-1477

NPI assigned

Mar 16, 2009

Organization subpart

No

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

Authorized official

Name

Rajesh Shetty, M. D.

Title

Owner

Phone

(904) 382-1477

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

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

{
    "created_epoch": "1237161600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1402444800000",
    "number": "1982845285",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1301 1ST ST S",
            "address_2": "SUITE 707",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322506443",
            "telephone_number": "904-382-1477"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11512 LAKE MEAD AVE",
            "address_2": "SUITE 534",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322569680",
            "telephone_number": "904-382-1477"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FLORIDA EYE SPECIALISTS PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-03-16",
        "last_updated": "2014-06-11",
        "status": "A",
        "authorized_official_last_name": "SHETTY",
        "authorized_official_first_name": "RAJESH",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "904-382-1477",
        "authorized_official_credential": "M. D."
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Ophthalmology",
            "state": "FL",
            "license": "ME84552",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSFL",
            "identifier": "28020",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "28020Z",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Ophthalmology Physician in Jacksonville, FL
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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2014; 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.