Active NPI
Bruce J Potter, O.D.
- Optometrist
- Tulare, CA
National Provider Identifier
1114083409
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- OPT 4601 TPA
- Practice address
- 440 E King Ave
Tulare, CA 93274-4223 - Phone
- (559) 686-8628
- Fax
- (559) 686-2507
- NPI assigned
- Dec 29, 2006
- Last updated
- Oct 24, 2008
- Sex
- Male
- Sole proprietor
- Yes
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 4601 TPA | CA | Primary |
Addresses
Primary practice location
440 E King Ave
Tulare, CA 93274-4223
Mailing address
440 E King Ave
Tulare, CA 93274-4223
Phone (559) 686-8628
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0678700001 | Other | CA | MEDICARE D DMERC (NAS) |
| 1801077953 | Other | CA | MEDICARE NPI GROUP |
| 94-1670985 | Other | CA | VISION SERVICE PLAN |
| YYY41591Y | Medicaid | CA |
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 |
|---|---|---|---|
| OPT 4601 TPA | CA | MD | Optometrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| DRS. Nagy & Potter, O.D. | Optometrist | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Optometrist
- Tulare, CA
- NPI 1801077953
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1167350400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1224806400000",
"number": "1114083409",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "440 E KING AVE",
"city": "TULARE",
"state": "CA",
"postal_code": "932744223",
"telephone_number": "559-686-8628",
"fax_number": "559-686-2507"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "440 E KING AVE",
"city": "TULARE",
"state": "CA",
"postal_code": "932744223",
"telephone_number": "559-686-8628",
"fax_number": "559-686-2507"
}
],
"practiceLocations": [],
"basic": {
"last_name": "POTTER",
"first_name": "BRUCE",
"middle_name": "J",
"name_prefix": "Dr.",
"credential": "O.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-12-29",
"last_updated": "2008-10-24",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "CA",
"license": "OPT 4601 TPA",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE D DMERC (NAS)",
"identifier": "0678700001",
"state": "CA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE NPI GROUP",
"identifier": "1801077953",
"state": "CA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "VISION SERVICE PLAN",
"identifier": "94-1670985",
"state": "CA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "YYY41591Y",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Tulare, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.