Dr. Samuel Hathy , OD
Optometrist • Jacksonville, FL
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. Samuel Hathy has officially deactivated this NPI record and ceased active healthcare practice.
Professional Overview & Biography Verified Profile Summary
Dr. Samuel Hathy, OD was a registered Optometrist practicing in Jacksonville, FL. Throughout an active medical career spanning 18 years, Dr. Hathy provided care at the practice location at 11111 SAN JOSE BLVD STE 44 until profile deactivation on 2025-09-18.
Historical Medicare Part B clinical services included photography of the retina, established patient complete exam of visual system, new patient complete exam of visual system. Public procedure reimbursement records and service volume details are provided below for historical transparency.
Practice Location & Contact Primary Location
11111 San Jose Blvd Ste 44
Jacksonville, FL 322237274
Specialty Benchmarks & Practice Insights
Comparative analytics for Optometrist in Jacksonville, FL
Practicing in Jacksonville, FL (3724 Statewide)
In-Person Office Visits Only
Under CMS Medicare Fee Schedule vs Standard Submitted Charges
Performed Procedures & Service Volume
Top Medicare Part B procedures performed by this practitioner
| HCPCS Code & Description | Services | Patients | Submitted Charge | Medicare Allowed |
|---|---|---|---|---|
|
92250
Photography of the retina
|
312 | 299 | $80.00 | $35.25 |
|
92014
Established patient complete exam of visual system
|
289 | 277 | $168.00 | $119.62 |
|
92004
New patient complete exam of visual system
|
24 | 24 | $168.00 | $141.73 |
|
92012
Established patient problem focused exam of visual system
|
18 | 18 | $93.00 | $84.54 |
|
99213
Established patient office or other outpatient visit, typically 15 minutes
|
17 | 16 | $119.00 | $88.32 |
Medical Specialties & State Licenses
NUCC Taxonomy Code: 152W00000X
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.
Practice Associates & Co-Workers
Healthcare professionals and specialists practicing at this location or sharing practice phone/fax
Optometrist
Doctor of Optometry
Career & Practice History Timeline
Chronological log of verified NPI updates, location relocations, credentials, and registry changes
Record deactivated on September 18, 2025
NPI status registered as active in NPPES database
Registered at 11111 SAN JOSE BLVD STE 44, JACKSONVILLE, FL 322237274 (Tel: 9042923976)
Registered at 11111 SAN JOSE BLVD STE 44, JACKSONVILLE, FL 322237274 (Tel: 9042923976)
Recorded as SAMUEL HATHY, O.D.
Optometrist (License #OPC 2361 in FL)
First registered as active Individual Practitioner in NPPES Database.
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NPI Administrative Meta
Mailing Address
11111 San Jose Blvd Ste 44
Jacksonville, FL 322237274
Phone: 9042923976
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