NPIMap

Organization Active NPI

Bradshaw Optometry

  • Preferred Provider Organization
  • Elk Grove, CA
National Provider Identifier
1073726022
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Preferred Provider OrganizationTaxonomy code 305R00000X
License
10618T Issued in CA
Legal business name
BRADSHAW OPTOMETRY
Practice address
8829 Sheldon Rd Ste 150
Elk Grove, CA 95624-5045
Phone
(916) 682-5558
Fax
(916) 688-5569
NPI assigned
May 7, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Paul K Kim, O.D.NPI 1841314408
Title
Owner Optometrist
Phone
(916) 682-5558

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
Preferred Provider Organization 305R00000X 10618T CA Primary

Addresses

Primary practice location

8829 Sheldon Rd Ste 150
Elk Grove, CA 95624-5045

Mailing address

8829 Sheldon Rd Ste 150
Elk Grove, CA 95624-5045
Phone (916) 682-5558

Other identifiers 4

IdentifierTypeStateIssuer
19222OtherCASPECTERA
SD0106180MedicaidCA
14460OtherCAMEDICAL EYE SERVICES
EYEMEDOtherCA118210

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 4

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": "1178496000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1073726022",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8829 SHELDON RD STE 150",
            "city": "ELK GROVE",
            "state": "CA",
            "postal_code": "956245045",
            "telephone_number": "916-682-5558",
            "fax_number": "916-688-5569"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8829 SHELDON RD STE 150",
            "city": "ELK GROVE",
            "state": "CA",
            "postal_code": "956245045",
            "telephone_number": "916-682-5558",
            "fax_number": "916-688-5569"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRADSHAW OPTOMETRY",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-07",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "KIM",
        "authorized_official_first_name": "PAUL",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "OWNER OPTOMETRIST",
        "authorized_official_telephone_number": "916-682-5558",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "305R00000X",
            "taxonomy_group": "",
            "desc": "Preferred Provider Organization",
            "state": "CA",
            "license": "10618T",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SPECTERA",
            "identifier": "19222",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "SD0106180",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL EYE SERVICES",
            "identifier": "14460",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "118210",
            "identifier": "EYEMED",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Elk Grove, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.