DR. FALLON DE VAY HENDERSON (OD) – Optometrist, NPI 1215772132

DR. FALLON DE VAY HENDERSON (OD) is a healthcare provider. based in Merritt island, Florida. specializing in OPTOMETRY. They hold the professional credentials OD. They hold a License No. OPC6523 (FL). The NPI Number for DR. FALLON DE VAY HENDERSON (OD) is 1215772132

Main info

Female
2 Years Of Experience
Accepts Medicare Assignment
Name
DR. FALLON DE VAY HENDERSON (OD)
NPI
1215772132
Phone
(321) 514-2340
Address
822 KILLARNEY CT
Enumeration Date
1 July 2024
Last Update Date
1 July 2024

Doctor Profile

Medical School Name
OTHER
Secondary Phone
3213831332
Graduation Year
2024 (2 years ago)
PAC ID
3274044540
Group Practice PAC ID
2860796091
Professional Enrollment ID
I20250613002220
Address ID
FL327805360TI1917XDRXX400
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience26
Completeness75
Years active:1State licenses:1Digital endpointsOther names

2,055 OPTOMETRY in FL

Provider Addresses for DR. FALLON DE VAY HENDERSON (OD)

  • 822 KILLARNEY CT

    MERRITT ISLAND, FL 329538065

    Phone: (321) 514-2340

    Type: Mailing

  • 13800 VETERANS WAY

    ORLANDO, FL 328277401

    Phone: (407) 599-1404

    Type: Location

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

PECOS enrollment status

Participating (accepts Medicare assignment)

Enrollment effective: 2025-06-13

PECOS data refreshed: 2026-05-27

Medicare revalidation (CMS due date list)

Due date not assigned yet

CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.

Enrollment records

1

Earliest due date

Not assigned (TBD)

CMS data updated

2026-06-01

Revalidation progress

  1. Medicare enrolled
  2. On CMS revalidation list
  3. Due date assigned
  4. Revalidate in PECOS

CMS enrollment records

Enrollment IDTypeSpecialtyStateDue date
I20250613002220IOptometryFLTBD

What to do next

  • No action required while the due date shows TBD.
  • Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
  • Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.

Verify on CMS Revalidation Lookup Tool

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 32953)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 2860796091View full group profile
NameSpecialtyState
O P T O M E T R YFL
O P T O M E T R YFL
O P T O M E T R YFL

Reviews

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Frequently asked questions

Can I use this page to confirm DR. FALLON DE VAY HENDERSON (OD)'s NPI?
Yes. DR. FALLON DE VAY HENDERSON (OD) is listed with NPI 1215772132 in the public NPI dataset.
Does CMS list DR. FALLON DE VAY HENDERSON (OD) as active?
Yes — DR. FALLON DE VAY HENDERSON (OD) is active in the NPI listing used on this page.
What taxonomy line describes DR. FALLON DE VAY HENDERSON (OD)?
For research purposes, treat DR. FALLON DE VAY HENDERSON (OD) as Optometrist in this dataset. Clinical services aligned with this taxonomy classification.
Where should I expect DR. FALLON DE VAY HENDERSON (OD) on a map?
Expect Merritt Island, Florida as a primary anchor for DR. FALLON DE VAY HENDERSON (OD) unless the record lists multiple sites.
Is specialty guaranteed by NPI alone?
Taxonomy selections describe intent; scope of practice still follows state law.

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