Active NPI
Kelsey Ann Cannon, O.D.
- Optometrist
- Oceanside, CA
National Provider Identifier
1093915514
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 13291
- Practice address
- 2100 Vista Way
Oceanside, CA 92054-5600 - Phone
- (760) 439-7413
- Fax
- (760) 439-8271
- NPI assigned
- Jul 23, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 13291 | CA | Primary |
Addresses
Primary practice location
2100 Vista Way
Oceanside, CA 92054-5600
Mailing address
12950 Carmel Creek Rd Unit 103
San Diego, CA 92130-2130
Phone (714) 745-1095
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 13291 | CA | MD | Optometrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1185148800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1305849600000",
"number": "1093915514",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12950 CARMEL CREEK RD UNIT 103",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921302130",
"telephone_number": "714-745-1095"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2100 VISTA WAY",
"city": "OCEANSIDE",
"state": "CA",
"postal_code": "920545600",
"telephone_number": "760-439-7413",
"fax_number": "760-439-8271"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CANNON",
"first_name": "KELSEY",
"middle_name": "ANN",
"name_prefix": "Mrs.",
"credential": "O.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-07-23",
"last_updated": "2011-05-20",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "CA",
"license": "13291",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Oceanside, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.