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JACKSONVILLE EYE CARE
NPI 1194074476
Optometrist in Phoenix, MD

Active since September 02, 2012CLIA 21D2322430 · Waiver
3332 PAPER MILL RD, PHOENIX, MD 21131(410) 628-1510 Get Directions Write a Review

NPPES record last updated: November 14, 2013. Verified against the NPPES registry weekly; last sync: August 09, 2026.

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

NPI1194074476
Entity TypeOrganization
Primary Taxonomy152W00000X
Legal Business NameM. F. DIFFENDALL OD PA
Location Address3332 PAPER MILL RDPhoenix, MD 21131-1419
Mailing Address3332 Paper Mill RdPhoenix, MD 21131-1419 · (410) 628-1510
Phone(410) 628-1510
Organization SubpartNo
Authorized OfficialMichael F DiffendallOwner · (410) 628-1510
Enumeration DateSeptember 2, 2012
Last NPPES UpdateNovember 14, 2013
✔ NPI 1194074476 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyOptometristEye and Vision Services Providers
Taxonomy Code152W00000X
License✔ Licensed in MD · TA1372
Definition
Doctors of optometry (ODs) are the primary health care professionals for the eye. Optometrists examine, diagnose, treat, and manage diseases, injuries, and disorders of the visual system, the eye, and associated structures as well as identify related systemic conditions affecting the eye. An optometrist has completed pre-professional undergraduate education in a college or university and four years of professional education at a college of optometry, leading to the doctor of optometry (O.D.) degree. Some optometrists complete an optional residency in a specific area of practice. Optometrists are eye health care professionals state-licensed to diagnose and treat diseases and disorders of the eye and visual system.
3332 PAPER MILL RD, Phoenix, MD 21131
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Other Names 1

Doing Business AsJacksonville Eye Care

Other Identifiers 2

Medicare PIN269669MD
Medicare UPINU60706

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Blue Cross and Blue Shield of Louisiana, Blue Cross Blue Shield of Wyoming, BlueCross BlueShield of Tennessee.Insurance ›

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, MD
Active · expires Apr 21, 2027
CLIA Number21D2322430
Laboratory TypePhysician Office
Certificate Effective DateApril 22, 2025
Certificate Expiration DateApril 21, 2027
Laboratory DirectorJohanna Letts
Laboratory Phone(410) 628-1510
Laboratory LocationJacksonville Eye Care3332 Paper Mill Rd, Phoenix, MD 21131
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 2

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. MICHAEL F DIFFENDALL OD
Optometrist
3332 PAPER MILL RD
PHOENIX, MD 21131
Baltimore County (410) 628-1510
JACKSONVILLE EYE CARE
Optometrist
3332 PAPER MILL RD
PHOENIX, MD 21131
Baltimore County (410) 628-1510

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 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.

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 Blue Cross Blue Shield of Wyoming, Blue Cross and Blue Shield of Louisiana and BlueCross BlueShield of Tennessee 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.