Individual provider Active NPI

Larry R Fabian, OD

  • Optometrist
  • San Jose, CA
National Provider Identifier
1104880129
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
OPT 6909 TPL Issued in CA
Practice address
1817 Hamilton Ave
San Jose, CA 95125
Phone
(408) 264-1555
Fax
(408) 264-1562
NPI assigned
Apr 14, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X OPT 6909 TPL CA Primary

Addresses

Primary practice location

1817 Hamilton Ave
San Jose, CA 95125

Mailing address

18660 Vista de Almaden
San Jose, CA 95120
Phone (408) 268-7621

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20090811000694 CA Practitioner - Optometry 8325192206 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Southern California College of Optometry, 1980
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1817 Hamilton Ave
San Jose, CA 95125-5624
Phone (408) 264-1555

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
OPT 6909 TPLCAMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Larry R Fabian & Jeffrey M Fannelli PTRS Westside Family Vision Center Optometrist CurrentSince Feb 1, 1986 Accepting new patients
Larry R Fabian & Jeffrey M Fanelli PTRS Westside Family Vision Center Optometrist Current Accepting new patients

Locations

1817 Hamilton Ave
San Jose, CA 95125
Phone (408) 264-1555

18800 Cox Ave
Saratoga, CA 95070

18816 Cox Ave
Saratoga, CA 95070

18780 Cox Ave
Saratoga, CA 95070
Phone (408) 370-7303

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1144972800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1104880129",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18660 VISTA DE ALMADEN",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "95120",
            "telephone_number": "408-268-7621",
            "fax_number": "408-268-7621"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1817 HAMILTON AVE",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "95125",
            "telephone_number": "408-264-1555",
            "fax_number": "408-264-1562"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FABIAN",
        "first_name": "LARRY",
        "middle_name": "R",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-14",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "OPT 6909 TPL",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Jose, CA

Sources for this page

Verify at the official NPI Registry.