OPTOMETRICA O D P A
NPI 1174879563
Optometrist in Sanibel, FL
About Optometrica O D P A NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
OPTOMETRICA O D P A (NPI 1174879563) is a healthcare organization registered as an optometrist in Sanibel, Florida and active in the NPI registry since August 2012. The organization lists Phong Michael Pham, President / Owner, as its authorized official.
NPPES Registry Identity
Specialties & Licenses
Group Practice 1
Medicare Participation & PECOS CMS
Medicare enrollment, revalidation and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Optometrica O D P A is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Medicare Revalidation Due Date
Revalidation due by November 30, 2026
Medicare-enrolled providers and suppliers confirm their enrollment information with CMS on a set cycle, every 5 years for most and every 3 years for medical equipment suppliers. CMS sets the due date for each enrollment.
Clinicians Billing Medicare Through This Organization
2Medicare enrollment records show 2 clinicians reassign Medicare billing to Optometrica O D P A, which bills Medicare for the services they deliver. Of these, 1 practice at this address. They are listed nearest first.
Clinicians, nearest first (2)
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Frequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Optometrica O D P A's NPI number?
The NPI number for Optometrica O D P A is 1174879563. It was assigned to this organization in the NPPES registry on August 3, 2012.
Where is Optometrica O D P A located?
Optometrica O D P A is located at 1571 Periwinkle Way, Sanibel, FL 33957. The listed phone number is (239) 560-6917.
What is Optometrica O D P A's specialty?
The primary specialty registered for this NPI is Optometrist with taxonomy code 152W00000X.
Is Optometrica O D P A enrolled in Medicare?
Yes. Optometrica O D P A is registered in the Medicare PECOS enrollment system.
When is Optometrica O D P A's Medicare revalidation due?
According to the CMS Revalidation Due Date List (October 2026 release), the Medicare Non-DME Part B enrollment for this organization (Florida, Clinic/Group Practice) is due for revalidation by November 30, 2026. Medicare providers and suppliers revalidate their enrollment every 5 years, and medical equipment suppliers every 3 years. Confirm current requirements with your Medicare Administrative Contractor.
How many clinicians bill Medicare through Optometrica O D P A?
According to the CMS Revalidation Reassignment List (October 2026 release), 2 clinicians, all in Optometry, reassign their Medicare billing to Optometrica O D P A. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Of these, 1 practice at this address. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
When was this NPI record last updated?
The NPPES record for Optometrica O D P A was last updated on October 1, 2012. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 14 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Optometrica O D P A · NPI 1174879563
Optometrist organization in Sanibel, Florida. Organization record, active in the CMS NPPES registry since August 3, 2012.
## Identity
- **NPI:** 1174879563 (Entity type: Organization)
- **Enumerated:** August 3, 2012
- **Primary specialty:** Optometrist · taxonomy 152W00000X
- **Organization subpart:** No
- **Authorized official:** Phong Pham, PRESIDENT / OWNER
## Practice location
- **Address:** 1571 PERIWINKLE WAY, Sanibel, FL 33957-4513
- **Phone:** (239) 560-6917 · **Fax:** (239) 415-7341
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Medicare revalidation due:** November 30, 2026 (Non-DME Part B, Florida, Clinic/Group Practice) · CMS Revalidation Due Date List, October 2026 release
- **Clinicians billing through this organization:** 2 clinicians (Optometry) reassign Medicare billing to this organization (form CMS-855R); 1 practice at this address · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** October 1, 2012
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Source: [NPI Profile](https://npiprofile.com/npi/1174879563) · Data from the CMS NPPES public registry.