Redwood Eye Center
Organization Active NPI Ophthalmology Physician · Vallejo, CA
NPI 1023061306 · NPPES record last updated Aug 22, 2020
Key facts
- NPI
- 1023061306
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Ophthalmology Physician 207W00000X
- License
- 00G231060 (CA)
- Legal business name
- REDWOOD EYE CENTER
- Practice address
- 2852 Redwood Pkwy
Vallejo, CA 94591-3633 - Phone
- (707) 553-8222
- Fax
- (707) 553-1154
- NPI assigned
- May 18, 2006
- Organization subpart
- No
Authorized official
- Name
- Mr. Roger F Carlson, MD
- Title
- President
- Phone
- (707) 553-8222
Practitioners 5
-
Roger F Carlson, MD
-
Quan Dao, O.D.
-
Laura E Schrupp, O.D.
-
Anthony K. Agadzi, M.D.
-
Denise Gamboa, OD
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20070724000700 | CA | Part B Supplier - Clinic/Group Practice | 8224139969 |
Receives reassigned benefits from 5 practitioners Practice locations: Vallejo, CA |
National Provider Directory
Locations
2700 Low Ct
Fairfield, CA 94534
Phone (707) 432-2500
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Ophthalmology Physician |
207W00000X | 00G231060 | CA | Yes |
Addresses
Primary practice location
2852 Redwood Pkwy
Vallejo, CA 94591-3633
Mailing address
2852 Redwood Pkwy
Vallejo, CA 94591-3633
Phone (707) 553-8222
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00G231060 | Other | CA | STATE LICENSE |
NPI Registry JSON
{
"created_epoch": "1147910400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1598054400000",
"number": "1023061306",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2852 REDWOOD PKWY",
"city": "VALLEJO",
"state": "CA",
"postal_code": "945913633",
"telephone_number": "707-553-8222",
"fax_number": "707-553-1154"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2852 REDWOOD PKWY",
"city": "VALLEJO",
"state": "CA",
"postal_code": "945913633",
"telephone_number": "707-553-8222",
"fax_number": "707-553-1154"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "REDWOOD EYE CENTER",
"organizational_subpart": "NO",
"enumeration_date": "2006-05-18",
"last_updated": "2020-08-22",
"status": "A",
"authorized_official_last_name": "CARLSON",
"authorized_official_first_name": "ROGER",
"authorized_official_middle_name": "F",
"authorized_official_title_or_position": "PRESIDENT",
"authorized_official_telephone_number": "707-553-8222",
"authorized_official_name_prefix": "Mr.",
"authorized_official_credential": "MD"
},
"taxonomies": [
{
"code": "207W00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Ophthalmology",
"state": "CA",
"license": "00G231060",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE LICENSE",
"identifier": "00G231060",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Vallejo, CA
- Jasmine Reber
- Rachelle Aguilar Recinto
- Jose L. Recio
- Jerry Stanley Redd
- Michael E. Reding
- Redwood Family & Cosmetic Dentistry
- Redwood Surgical Institute
- Pat Regan
- David Aaron Reinstein
- Vanessa Nicole Reis
All providers in Vallejo, CA · Ophthalmology Physician in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 22, 2020. 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.