Active NPI
Larry R Fabian, OD
- Optometrist
- San Jose, CA
National Provider Identifier
1104880129
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- OPT 6909 TPL
- 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
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 | 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
Enrollment records 1
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
| License | State | Type | Specialty |
|---|---|---|---|
| OPT 6909 TPL | CA | MD | Optometrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Larry R Fabian & Jeffrey M Fannelli PTRS Westside Family Vision Center | Optometrist | Current | 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.
-
- Optometrist
- Saratoga, CA
- NPI 1255406690
-
- Optometrist
- San Jose, CA
- NPI 1518061159
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
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.