NPIMap

Organization Active NPI

Advanced Family Vision Center Inc

Doing business as Advanced Family Vision

  • Optometrist
  • Moorpark, CA
National Provider Identifier
1043488547
Registry record updated Feb 19, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
13135 Issued in CA
Legal business name
ADVANCED FAMILY VISION CENTER INC
Doing business as
Advanced Family Vision
Practice address
766 Los Angeles Ave
Suite D3
Moorpark, CA 93021
Phone
(805) 624-1254
NPI assigned
Feb 19, 2008
Last updated
Feb 19, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 19, 2008

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

Authorized official

Name
Dr. Kimberly Ann Tedder, ODNPI 1477606945
Title
Optometrist-Owner
Phone
(805) 524-1254

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 13135 CA Primary

Addresses

Primary practice location

766 Los Angeles Ave
Suite D3
Moorpark, CA 93021

Mailing address

766 Los Angeles Ave
Suite D3
Moorpark, CA 93021

Other names 1

  • Advanced Family Vision Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090427000285 CA Part B Supplier - Clinic/Group Practice 2961550231 Receives reassigned benefits from 5 practitioners
Practice locations: Moorpark, CA

National Provider Directory

National Provider Directory

Locations

766 New Los Angeles Ave
Ste D3
Moorpark, CA 93021
Phone (805) 523-3440

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1203379200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1203379200000",
    "number": "1043488547",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "766 LOS ANGELES AVE",
            "address_2": "SUITE D3",
            "city": "MOORPARK",
            "state": "CA",
            "postal_code": "93021"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "766 LOS ANGELES AVE",
            "address_2": "SUITE D3",
            "city": "MOORPARK",
            "state": "CA",
            "postal_code": "93021",
            "telephone_number": "805-624-1254"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADVANCED FAMILY VISION CENTER INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-02-19",
        "last_updated": "2008-02-19",
        "status": "A",
        "authorized_official_last_name": "TEDDER",
        "authorized_official_first_name": "KIMBERLY",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "OPTOMETRIST-OWNER",
        "authorized_official_telephone_number": "805-524-1254",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "CA",
            "license": "13135",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Advanced Family Vision",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Moorpark, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 19, 2008; 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.