PELICAN PLAZA OPTICAL NPI 1023295763

Durable Medical Equipment & Medical Supplies in Sarasota, FL

NPI 1023295763 Organization Durable Medical Equipment & Medical Supp...

About PELICAN PLAZA OPTICAL

Pelican Plaza Optical is a provider established in Sarasota, Florida specializing in durable medical equipment & medical supplies. The NPI number of Pelican Plaza Optical is 1023295763 and was assigned on January 2008. The practitioner's primary taxonomy code is 332B00000X with license number 3259 (FL). The provider is registered as an organization and their NPI record was last updated 13 years ago. The authorized official of this NPI record is Mr. John Grondahl D.o. (Optician/owner)

NPI

1023295763

Provider NamePELICAN PLAZA OPTICAL
Provider Location Address8390 S TAMIAMI TRL SARASOTA, FL 34238
Provider Mailing Address8390 S TAMIAMI TRL SARASOTA, FL 34238
NPI Entity TypeOrganization
Is Sole Proprietor?N/A
Is Organization Subpart?No
Enumeration Date01-24-2008
Last Update Date03-24-2008


Primary Taxonomy

Taxonomy Code332B00000X
ClassificationDurable Medical Equipment & Medical Supplies
TypeSuppliers
License No.3259
License StateFL
Taxonomy DescriptionA supplier of medical equipment such as respirators, wheelchairs, home dialysis systems, or monitoring systems, that are prescribed by a physician for a patient's use in the home and that are usable for an extended period of time.

Business Address

PELICAN PLAZA OPTICAL
8390 S TAMIAMI TRL
SARASOTA, FL
ZIP 34238
Phone: (941) 966-1559
Fax: (941) 966-1559

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Mailing Address

PELICAN PLAZA OPTICAL
8390 S TAMIAMI TRL
SARASOTA, FL
ZIP 34238
Phone: (941) 966-1559
Fax: (941) 966-1559



Authorized Official

Authorized Official NameMR. JOHN GRONDAHL D.O.
Authorized Official TitleOPTICIAN/OWNER
Authorized Official Phone(941) 966-1559

Secondary Taxonomies


The secondary taxonomy codes define the provider type, classification, and specialization. For individual NPIs the license data is associated to each taxonomy code.

No. Taxonomy Code Type Classification Specialization License No. State Primary
1335E00000XSuppliersProsthetic/Orthotic Supplier3259FLNo

Taxonomy Description: an organization that provides prosthetic and orthotic care which may include, but is not limited to, patient evaluation, prosthesis or orthosis design, fabrication, fitting and modification to treat limb loss for purposes of restoring physiological function and/or cosmesis or to treat a neuromusculoskeletal disorder or acquired condition.

Additional Identifiers


Additional identifier(s) currently or formerly used as an identifier for the provider. The codes may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.

Identifier Type / Code Identifier State
0897930001MEDICARE PIN (08)FL
0897930001MEDICARE NSC (07)FL

NPI Footnotes

What is the National Provider Indentifier (NPI)?
The NPI is 10-position all-numeric identification number assigned by the NPPES to uniquely identify a health care provider.

Provider Location Address
The location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.

Provider Mailing Address
The mailing address of the provider being identified. This address may contain the same information as the provider location address.

Entity Type Code
The code describing the type of health care provider that is being assigned an NPI.
The entity type codes are:
1 = Person: individual human being who furnishes health care;
2 = Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)

What is a Subpart?
Subparts are the components and separate physical locations of organization health care providers. Subpart examples include:
Hospital components include outpatient departments, surgical centers, psychiatric units, and laboratories. These components are often separately licensed or certified by States and may exist at physical locations other than that of the hospital of which they are a component.

Provider Other Organization Name
The other organization name is the alternative last name by which the provider is or has been known (if an individual) or other name by which the organization provider is or has been known. The code identifying the type of other name. The provider other organization name codes are:
1 = former name;
2 = professional name;
3 = doing business as (d/b/ a) name;
4 = former legal business name; :
5 = other.

Provider Enumeration Date
The date the provider was assigned a unique identifier (assigned an NPI).

Last Update Date
The date that a NPI record was last updated or changed.

Primary Taxonomy Code
The primary taxonomy code defines the provider type, classification, and specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.

Authorized Official Name
The name of the person authorized to submit the NPI application or to officially change data for a health care provider.