Independent US Healthcare Provider Directory & Public Medical Database
Deactivated NPI 1114300472 Deactivated / Inactive NPI Male Practitioner

Dr. Benjamin John Konynenbelt , OD

Optometrist • Estero, FL

✓ Accepts Medicare Assignment
⚠️

Notice of NPI Deactivation & Inactive Practice Status

According to official public domain records published by CMS (Centers for Medicare & Medicaid Services) in the National Provider Identifier (NPPES) Registry, Dr. Benjamin Konynenbelt has officially deactivated this NPI record and ceased active healthcare practice.

Registration / Start Date July 06, 2015
NPI Deactivation Date November 20, 2024
Total Practice Duration ~9 Years of Practice (2015 – 2024)

Professional Overview & Biography Verified Profile Summary

Dr. Benjamin Konynenbelt, OD was a registered Optometrist in Estero, FL. Prior to record deactivation on 2024-11-20, Dr. Konynenbelt completed approximately 9 years of clinical practice following graduation from Indiana University - School Of Optometry in 2015.

Dr. Konynenbelt was affiliated with Edison Eye Care Pllc and accepted Medicare assignment.

Historical Medicare Part B clinical services included new patient outpatient office visit, exam to measure eye deviation and range of motion, established patient outpatient office visit. Public procedure reimbursement records and service volume details are provided below for historical transparency.

Practice Location & Contact Primary Location

Practice Address

19527 Highland Oaks Dr Ste 203

Estero, FL 339289637

Telephone 2393178200
Associated Practice Facility / Clinic
🏢 Edison Eye Care, Pllc Facility NPI 1255055646

Medicare Profile & Education

Medical School

Indiana University - School Of Optometry

Graduation Year

2015

Medicare Assignment

✓ Accepts Assignment

Telehealth Flag

In-Person Only

Specialty Benchmarks & Practice Insights

Comparative analytics for Optometrist in Estero, FL

Established Specialist (10-20 Yrs)
Practitioner Clinical Experience
11 Yrs -7.0 yrs vs City Avg
City Avg: 18.0 Yrs
State Avg: 22.7 Yrs
Regional Practice Density
7 Specialists

Practicing in Estero, FL (3724 Statewide)

Telehealth Adoption Rate
0.0% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount
22.8% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Clinical Seniority & Experience Comparison

Dr. Konynenbelt (11 Years) 11 Yrs
Estero Specialty Average (18.0 Years) 18.0 Yrs

Performed Procedures & Service Volume

Top Medicare Part B procedures performed by this practitioner

CMS Official Data (2024)
Reporting Year:
HCPCS Code & Description Services Patients Submitted Charge Medicare Allowed
99204 New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more
36 36 $200.00 $170.18
92060 Exam to measure eye deviation and range of motion
31 22 $95.00 $62.82
99213 Established patient office or other outpatient visit, typically 15 minutes
21 15 $123.81 $91.69
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more
16 13 $175.00 $129.41
92004 New patient complete exam of visual system
12 12 $161.25 $139.36
92134 Imaging of retina
12 12 $62.50 $38.07

Medical Specialties & State Licenses

CMS Verified: 2024-12-11
Optometrist Primary Specialty

NUCC Taxonomy Code: 152W00000X

State License FL OPC5272

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.

Hospital & Practice Group Affiliations

Edison Eye Care Pllc

19527 Highland Oaks Dr, Estero, FL 339289637

Phone: 2393178200

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

1 Associated Practitioners
NPI 1659749323

Doctor of Optometry

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

17 Historical Events
📍
Updated Practice Location December 11, 2024

Registered at 19527 HIGHLAND OAKS DR STE 203, ESTERO, FL 339289637 (Tel: 2393178200)

📍
Updated Business Mailing Address December 11, 2024

Registered at 19527 HIGHLAND OAKS DR STE 203, ESTERO, FL 339289637 (Tel: 2393178200)

🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) December 11, 2024

Optometrist (License #OPC5272 in FL)

🔄
NPI Profile Reactivated November 27, 2024

Record officially reactivated for active practice on November 27, 2024

⚠️
NPI Profile Deactivated November 20, 2024

Record deactivated on November 20, 2024

🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) July 21, 2022

Optometrist (License #3237 in TN)

NPI Profile Active June 23, 2017

NPI status registered as active in NPPES database

📍
Updated Practice Location June 23, 2017

Registered at 2551 DREW ST, CLEARWATER, FL 337652839 (Tel: 7277911214)

📍
Updated Business Mailing Address June 23, 2017

Registered at 1950 OLD GALLOWS RD STE 520, VIENNA, VA 221823970 (Tel: (703) 847-8899)

👤
Provider Name / Credentials Updated June 23, 2017

Recorded as BENJAMIN KONYNENBELT, O.D.

🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) June 23, 2017

Optometrist (License #OPC5272 in FL)

NPI Profile Active July 06, 2015

NPI status registered as active in NPPES database

📍
Updated Practice Location July 06, 2015

Registered at 1245 MADISON AVE, MEMPHIS, TN 381042211 (Tel: 9017223200)

📍
Updated Business Mailing Address July 06, 2015

Registered at 1690 HUNTERS TRACE DR APT 302, MEMPHIS, TN 381204475 (Tel: 6168342598)

👤
Provider Name / Credentials Updated July 06, 2015

Recorded as BENJAMIN KONYNENBELT, O.D.

🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) July 06, 2015

Optometrist (License #3237 in TN)

🟢
Initial NPI Registration & Enumeration July 06, 2015

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

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NPI Administrative Meta

NPI Number: 1114300472
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: July 06, 2015
Last Update: December 11, 2024
Deactivation Date: November 20, 2024
Sole Proprietor: No

Mailing Address

19527 Highland Oaks Dr Ste 203

Estero, FL 339289637

Phone: 2393178200

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).
⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.