Brian Rex Alcalde, O.D.
Individual provider Active NPI Optometrist · La Puente, CA
NPI 1013035443 · NPPES record last updated Jul 13, 2015
Key facts
- NPI
- 1013035443
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Optometrist 152W00000X
- License
- 13191T (CA)
- Practice address
- 1641 N Hacienda Blvd
La Puente, CA 91744-1137 - Phone
- (626) 918-1407
- Fax
- (626) 918-2069
- NPI assigned
- Mar 26, 2007
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 3
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20090106000125 | CA | Practitioner - Optometry | 6204999030 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 13191T | CA | MD | Optometrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Chino Optometry Center | Optometrist | Current |
Accepting new patients |
| Clear Sight Optometry Corp | Optometrist | Past |
Accepting new patients |
| Andrew G Chong, O.D. | Optometrist | Past | Accepting new patients |
Locations
11640 Central Ave
Chino, CA 91710
Phone (909) 627-7363
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 13191T | CA | Yes |
Addresses
Primary practice location
1641 N Hacienda Blvd
La Puente, CA 91744-1137
Mailing address
165 S Jeanine Way
Anaheim, CA 92806-3840
Phone (714) 322-9520
Other providers in La Puente, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 13, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.