JACKSONVILLE EYE CARE
NPI 1194074476
Optometrist in Phoenix, MD
About Jacksonville Eye Care NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
JACKSONVILLE EYE CARE (NPI 1194074476) is a healthcare organization registered as an optometrist in Phoenix, Maryland and active in the NPI registry since September 2012. The organization holds a CLIA Waiver certificate valid through April 21, 2027 and lists Michael F Diffendall, Owner, as its authorized official.
NPPES Registry Identity
Specialties & Licenses
Other Names 1
Other Identifiers 2
Group Practice 1
Accepted Insurance
Medicare Participation & PECOS CMS
Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Jacksonville Eye Care is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Clinicians Billing Medicare Through This Organization
2Medicare enrollment records show 2 clinicians reassign Medicare billing to Jacksonville Eye Care, 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.
CLIA Laboratory Certificates CMS CLIA
Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.
Certificate of Waiver 21D2322430
Jacksonville Eye Care · Phoenix, MDFrequently 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 M. F. Diffendall Od PA's NPI number?
The NPI number for M. F. Diffendall Od PA is 1194074476. It was assigned to this organization in the NPPES registry on September 2, 2012. The provider is doing business as Jacksonville Eye Care.
Where is M. F. Diffendall Od PA located?
M. F. Diffendall Od PA is located at 3332 Paper Mill Rd, Phoenix, MD 21131. The listed phone number is (410) 628-1510.
What is M. F. Diffendall Od PA's specialty?
The primary specialty registered for this NPI is Optometrist with taxonomy code 152W00000X.
Is M. F. Diffendall Od PA enrolled in Medicare?
Yes. M. F. Diffendall Od PA is registered in the Medicare PECOS enrollment system.
How many clinicians bill Medicare through M. F. Diffendall Od PA?
According to the CMS Revalidation Reassignment List (October 2026 release), 2 clinicians, all in Optometry, reassign their Medicare billing to M. F. Diffendall Od PA. 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.
Does M. F. Diffendall Od PA hold a CLIA laboratory certificate?
Yes. A Certificate of Waiver (number 21D2322430) is associated with this NPI, valid through April 21, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.
What insurance does M. F. Diffendall Od PA accept?
Health plans from Anthem Blue Cross and Blue Shield, Blue Cross Blue Shield of Wyoming, Blue Cross and Blue Shield of Louisiana, Blue Cross and Blue Shield of Montana and Blue Cross and Blue Shield of Oklahoma and 2 other insurers list M. F. Diffendall Od PA as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.
When was this NPI record last updated?
The NPPES record for M. F. Diffendall Od PA was last updated on November 14, 2013. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 12 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.
# Jacksonville Eye Care · NPI 1194074476
Optometrist organization in Phoenix, Maryland. Organization record, active in the CMS NPPES registry since September 2, 2012.
## Identity
- **NPI:** 1194074476 (Entity type: Organization)
- **Enumerated:** September 2, 2012
- **Primary specialty:** Optometrist · taxonomy 152W00000X
- **Legal business name:** M. F. Diffendall Od Pa
- **Organization subpart:** No
- **Authorized official:** Michael Diffendall, OWNER
## Practice location
- **Address:** 3332 PAPER MILL RD, Phoenix, MD 21131-1419
- **Phone:** (410) 628-1510
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **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:** November 14, 2013
- **Other identifiers:** Medicare PIN 269669 (MD); Medicare UPIN U60706
- **CLIA laboratory certificates:** 1 on file
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Source: [NPI Profile](https://npiprofile.com/npi/1194074476) · Data from the CMS NPPES public registry.