Provider Demographics
NPI:1942299847
Name:KAPADIA, SHAROKH NANI (OD)
Entity Type:Individual
Prefix:
First Name:SHAROKH
Middle Name:NANI
Last Name:KAPADIA
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:161-3 HAMPTON POINT DRIVE
Mailing Address - Street 2:
Mailing Address - City:ST. AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32092
Mailing Address - Country:US
Mailing Address - Phone:904-287-9137
Mailing Address - Fax:904-287-9057
Practice Address - Street 1:161-3 HAMPTON POINT DRIVE
Practice Address - Street 2:
Practice Address - City:ST. AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32092
Practice Address - Country:US
Practice Address - Phone:904-287-9137
Practice Address - Fax:904-287-9057
Is Sole Proprietor?:No
Enumeration Date:2005-10-14
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC3241152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OPC3241OtherVISION CARE PLAN (VCP)
OPC3241OtherVISION SERVICE PLAN (VSP)
20884OtherBLUE CROSS/BLUE SHIELD
33447OtherCOORDINATED VISION
7005022OtherAETNA
OPC3241OtherOPTICARE EYE HEALTH
FL620800200Medicaid
FL7400500001OtherMEDICARE DME
289291OtherAVMED
FL20884ZMedicare PIN
FL620800200Medicaid