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ST JOHNS EYE ASSOCIATES PA
NPI 1609502178
Optometrist in Jacksonville, FL

Active since July 27, 2022
2039 HENDRICKS AVENUE, UNIT 213, JACKSONVILLE, FL 32207(904) 287-9137(904) 287-9057 Get Directions Write a Review

NPPES record last updated: July 27, 2022. Verified against the NPPES registry weekly; last sync: October 18, 2026.

About St Johns Eye Associates Pa NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

ST JOHNS EYE ASSOCIATES PA (NPI 1609502178) is a healthcare organization registered as an optometrist in Jacksonville, Florida and active in the NPI registry since July 2022. The organization lists Donna Marie Backs, Credentialing, as its authorized official.

NPPES Registry Identity

NPI1609502178
Entity TypeOrganization
Primary Taxonomy152W00000X
Legal Business NameST JOHNS EYE ASSOCIATES PA
Location Address2039 HENDRICKS AVENUE, UNIT 213Jacksonville, FL 32207-3209
Mailing Address161 Hampton Point Dr Ste 3St Augustine, FL 32092-3058 · (805) 433-2901
Phone(904) 287-9137
Fax(904) 287-9057
Organization SubpartNo
Authorized OfficialDonna Marie BacksCredentialing · (805) 433-2901
Enumeration DateJuly 27, 2022
NPPES CertifiedJune 30, 2022
✔ NPI 1609502178 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyOptometristEye and Vision Services Providers
Taxonomy Code152W00000X
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.
2039 HENDRICKS AVENUE, Jacksonville, FL 32207
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Other Names 1

Other NameSt Johns Eye Associates At San Marco

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 Florida Blue (BlueCross BlueShield FL), Florida Blue HMO (a BlueCross BlueShield FL company).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)

St Johns Eye Associates Pa is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

11

Medicare enrollment records show 11 clinicians reassign Medicare billing to St Johns Eye Associates PA, which bills Medicare for the services they deliver. Of these, 2 practice within 10 miles. They are listed nearest first.

Clinicians, nearest first (11)

Morgan Kickliter
Optometry
NPI 1487146635
10400 SAN JOSE BLVD STE 6
Jacksonville, FL 32257
(904) 880-1818
✔ PECOS✔ Accepts Medicare8.0 mi
Dea Opari
Optometry
NPI 1245075001
11406 SAN JOSE BLVD STE 1
Jacksonville, FL 32223
(904) 578-1981
✔ PECOS9.6 mi
Diane Kapadia, OD
Optometry
NPI 1760471668
161 HAMPTON POINT DR STE 3
St Augustine, FL 32092
(904) 287-9137
✔ PECOS✔ Accepts Medicare18 mi
Sharokh Kapadia, OD
Optometry
NPI 1942299847
161-3 HAMPTON POINT DRIVE
St. Augustine, FL 32092
(904) 287-9137
✔ PECOS✔ Accepts Medicare18 mi
Shawna Moinipour, O.D.
Optometry
NPI 1447091657
161 HAMPTON POINT DR STE 3
St Augustine, FL 32092
(904) 287-9137
✔ PECOS✔ Accepts Medicare18 mi
Chelsea Nissinoff, OD
Optometry
NPI 1720715634
161 HAMPTON POINT DR STE 3
St Augustine, FL 32092
(904) 287-9137
✔ PECOS✔ Accepts Medicare18 mi
Jhaleil Phillips, OD
Optometry
NPI 1972111847
161 HAMPTON POINT DR STE 3
Saint Augustine, FL 32092
(904) 287-9137
✔ PECOS✔ Accepts Medicare18 mi
Samantha Price
Optometry
NPI 1538511993
161 HAMPTON POINT DR STE 3
Saint Augustine, FL 32092
(904) 287-9137
✔ PECOS✔ Accepts Medicare18 mi
Dillon Smith, OD
Optometry
NPI 1245722917
161 HAMPTON POINT DR STE 3
St Augustine, FL 32092
(904) 287-9137
✔ PECOS✔ Accepts Medicare18 mi
Ngan Kim Lam
Optometry
NPI 1407423247
200 NOCATEE VILLAGE DR
Ponte Vedra, FL 32081
(904) 825-4525
✔ PECOS✔ Accepts Medicare19 mi
Gina Kubesh, OD
Optometry
NPI 1538042767
150 VILLAGE COMMONS DR STE 102
St Augustine, FL 32092
(904) 530-9802
✔ PECOS✔ Accepts Medicare25 mi

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 10D2270472

St Johns Eye Associates, PA · Jacksonville, FL
Expired · Oct 16, 2026
CLIA Number10D2270472
Laboratory TypePhysician Office
Certificate Effective DateOctober 17, 2024
Certificate Expiration DateOctober 16, 2026
Laboratory DirectorSharokh Kapadia
Laboratory Phone(904) 622-0844
Laboratory LocationSt Johns Eye Associates, PA2039 Hendricks Ave Unit 213, Jacksonville, FL 32207
CLIA data matches this NPI record on: Address Name
This certificate is issued to a laboratory to perform only waived tests.

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 St Johns Eye Associates PA's NPI number?

The NPI number for St Johns Eye Associates PA is 1609502178. It was assigned to this organization in the NPPES registry on July 27, 2022. The provider is also known as St Johns Eye Associates at San Marco.

Where is St Johns Eye Associates PA located?

St Johns Eye Associates PA is located at 2039 Hendricks Avenue Unit 213, Jacksonville, FL 32207. The listed phone number is (904) 287-9137.

What is St Johns Eye Associates PA's specialty?

The primary specialty registered for this NPI is Optometrist with taxonomy code 152W00000X.

Is St Johns Eye Associates PA enrolled in Medicare?

Yes. St Johns Eye Associates PA is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through St Johns Eye Associates PA?

According to the CMS Revalidation Reassignment List (October 2026 release), 11 clinicians, all in Optometry, reassign their Medicare billing to St Johns Eye Associates 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, 2 practice within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

What insurance does St Johns Eye Associates PA accept?

Health plans from Florida Blue (BlueCross BlueShield FL) and Florida Blue HMO (a BlueCross BlueShield FL company) list St Johns Eye Associates 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 St Johns Eye Associates PA was last updated on July 27, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 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.