NPIMap

Organization Active NPI

Primary Eyecare Center, an Optometric Practice

  • Optometrist
  • San Luis Obispo, CA
National Provider Identifier
1013034537
Registry record updated May 25, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
Legal business name
PRIMARY EYECARE CENTER, AN OPTOMETRIC PRACTICE
Practice address
764 Santa Rosa St
San Luis Obispo, CA 93401-2804
Phone
(805) 543-1447
Fax
(805) 543-4778
NPI assigned
Mar 22, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 25, 2012

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

Authorized official

Name
Mr. Steven Sage Hider, O.D.NPI 1497739106
Title
Optometrist and Partner
Phone
(805) 466-3777

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X CA Primary

Addresses

Primary practice location

764 Santa Rosa St
San Luis Obispo, CA 93401-2804

Mailing address

764 Santa Rosa St
San Luis Obispo, CA 93401-2804
Phone (805) 543-1447

Other identifiers 2

IdentifierTypeStateIssuer
GSD000531MedicaidCA
CD9792OtherCARAILROAD MEDICARE

Other names 1

  • Primary Eyecare Center Former legal business name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20041229000869 CA Part B Supplier - Clinic/Group Practice 1456319979 Receives reassigned benefits from 6 practitioners
1 other NPI on this enrollment
Practice locations: Atascadero, CA; San Luis Obispo, CA
O20100930097084 CA DME Supplier - Physician - Optometrist 1456319979 Practice locations: San Luis Obispo, CA

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Primary Eyecare Center2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

7605 Morro Rd
Atascadero, CA 93422
Phone (805) 466-3777

764 Santa Rosa St
Sn Luis Obisp, CA 93401
Phone (805) 543-1447

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1174521600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1337904000000",
    "number": "1013034537",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "764 SANTA ROSA ST",
            "city": "SAN LUIS OBISPO",
            "state": "CA",
            "postal_code": "934012804",
            "telephone_number": "805-543-1447",
            "fax_number": "805-543-4778"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "764 SANTA ROSA ST",
            "city": "SAN LUIS OBISPO",
            "state": "CA",
            "postal_code": "934012804",
            "telephone_number": "805-543-1447",
            "fax_number": "805-543-4778"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRIMARY EYECARE CENTER, AN OPTOMETRIC PRACTICE",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-22",
        "last_updated": "2012-05-25",
        "status": "A",
        "authorized_official_last_name": "HIDER",
        "authorized_official_first_name": "STEVEN",
        "authorized_official_middle_name": "SAGE",
        "authorized_official_title_or_position": "OPTOMETRIST AND PARTNER",
        "authorized_official_telephone_number": "805-466-3777",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "CA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GSD000531",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "CD9792",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Primary Eyecare Center",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in San Luis Obispo, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 25, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.