NPIMap

Organization Active NPI

Children'S Specialists of San Diego - Div of Opth

  • Ophthalmology Physician
  • San Diego, CA
National Provider Identifier
1013074590
Registry record updated Apr 22, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
Legal business name
CHILDREN'S SPECIALISTS OF SAN DIEGO - DIV OF OPTH
Practice address
3030 Childrens Way
Suite 109
San Diego, CA 92123-4232
Phone
(858) 309-7701
NPI assigned
Jan 3, 2007
Organization subpart
Yes
Parent organization
CHILDREN'S SPECIALISTS OF SAN DIEGOAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 22, 2008

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

Authorized official

Name
Herbert C. Kimmons Jr., M.D.
Title
President
Phone
(858) 966-8567

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ophthalmology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207W00000X Primary

Addresses

Primary practice location

3030 Childrens Way
Suite 109
San Diego, CA 92123-4232

Mailing address

3860 Calle Fortunada
Suite 210
San Diego, CA 92123-4800
Phone (858) 309-6303

Other identifiers 1

IdentifierTypeStateIssuer
GR0068865MedicaidCA

Other names 1

  • Children's Associated Medical Group Former legal business name

National Provider Directory

National Provider Directory
Tax ID family
Children'S Specialists of San Diego - Div of Neo24 organizations share this tax ID, including this one
Part of
Children'S Specialists of San Diego - Div of Neo

Other organizations with this tax ID 23

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

View all 23

Locations

3030 Childrens Way
Ste 109
San Diego, CA 92123
Phone (858) 309-7701

NPI Registry JSON

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

{
    "created_epoch": "1167782400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1208822400000",
    "number": "1013074590",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3860 CALLE FORTUNADA",
            "address_2": "SUITE 210",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921234800",
            "telephone_number": "858-309-6303",
            "fax_number": "858-309-6301"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3030 CHILDRENS WAY",
            "address_2": "SUITE 109",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921234232",
            "telephone_number": "858-309-7701"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHILDREN'S SPECIALISTS OF SAN DIEGO - DIV OF OPTH",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CHILDREN'S SPECIALISTS OF SAN DIEGO",
        "enumeration_date": "2007-01-03",
        "last_updated": "2008-04-22",
        "status": "A",
        "authorized_official_last_name": "KIMMONS",
        "authorized_official_first_name": "HERBERT",
        "authorized_official_middle_name": "C.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "858-966-8567",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Ophthalmology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0068865",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Children's Associated Medical Group",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in San Diego, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 22, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.