Individual provider Active NPI

Ronald Santiago Garcia, O.D.

  • Optometrist
  • San Rafael, CA
National Provider Identifier
1003968199
Registry record updated Jul 26, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
9673T Issued in CA
Practice address
1436 4TH St
San Rafael, CA 94901-2812
Phone
(415) 454-0354
Fax
(415) 454-0497
NPI assigned
Jan 17, 2007
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 26, 2013

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 9673T CA Primary

Addresses

Primary practice location

1436 4TH St
San Rafael, CA 94901-2812

Mailing address

1436 4TH St
San Rafael, CA 94901-2812
Phone (415) 454-0354

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20121025000176 CA Practitioner - Optometry 8628228855 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
University of California - School of Optometry, 1991
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Fyidoctors of California IncGroup PAC ID 3577961572, 21 clinicians

Practice addresses (Care Compare)

1039 El Monte Ave
Suite K
Mountain View, CA 94040-2371
Phone (650) 967-0140

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
9673TCAMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Fyidoctors of California, Inc. Optometrist CurrentSince Sep 12, 2023 Accepting new patients
Brent P. Chinn, OD and David M. Redman, OD, Optometric Group, Inc Optometrist PastSince Apr 5, 2010 Accepting new patients
Eyedesigns Optometry Optometrist Past Accepting new patients

Locations

1039 El Monte Ave
Ste K
Mountain View, CA 94040
Phone (650) 967-0140

114 N Sunrise Ave
Ste C4
Roseville, CA 95661
Phone (916) 786-2212

1436 4th St
San Rafael, CA 94901
Phone (415) 454-0354

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1168992000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1374796800000",
    "number": "1003968199",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1436 4TH ST",
            "city": "SAN RAFAEL",
            "state": "CA",
            "postal_code": "949012812",
            "telephone_number": "415-454-0354",
            "fax_number": "415-454-0497"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1436 4TH ST",
            "city": "SAN RAFAEL",
            "state": "CA",
            "postal_code": "949012812",
            "telephone_number": "415-454-0354",
            "fax_number": "415-454-0497"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GARCIA",
        "first_name": "RONALD",
        "middle_name": "SANTIAGO",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-01-17",
        "last_updated": "2013-07-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "9673T",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Rafael, CA

Sources for this page

Verify at the official NPI Registry.