Edmundo Charles Fimbres, O.D.
Individual provider
Active NPI
Optometrist · Seaside, CA
NPI 1033199575 · NPPES record last updated Jan 9, 2018
Key facts
- NPI
- 1033199575
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Optometrist 152W00000X
- License
- 6655T (CA)
- Practice address
- 915 Hilby Ave
Suite 1
Seaside, CA 93955-5339
- Phone
- (831) 899-2020
- Fax
- (831) 899-5504
- NPI assigned
- Jan 19, 2006
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 1
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.
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 |
|---|
| I20190122002197 |
CA |
Practitioner - Optometry |
2769729250 |
|
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|
| 6655T | CA | MD | Optometrist |
Practice roles
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|
| Optometrist |
152W00000X |
6655T |
CA |
Yes |
Addresses
Primary practice location
915 Hilby Ave
Suite 1
Seaside, CA 93955-5339
Mailing address
915 Hilby Ave
Ste 1
Seaside, CA 93955-5339
Phone (831) 899-2020
Other identifiers
| Identifier | Type | State | Issuer |
|---|
| GROOO1660 | Medicaid | CA | |