NPIMap

Organization Active NPI

San Tan Eyecare PLC

  • Optometrist
  • Gilbert, AZ
National Provider Identifier
1114101136
Registry record updated Mar 7, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
1307 Issued in AZ
Legal business name
SAN TAN EYECARE PLC
Practice address
2680 S Val Vista Dr
Suite 111
Gilbert, AZ 85295-1606
Phone
(480) 807-0288
Fax
(480) 290-7199
NPI assigned
Dec 27, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 7, 2012

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

Authorized official

Name
Dr. Jack L Hostetler, ODNPI 1760486500
Title
Member
Phone
(480) 807-0288

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193200000X MULTI-SPECIALTY GROUP 152W00000X 1307 AZ Primary
OptometristGroup: 193200000X MULTI-SPECIALTY GROUP 152W00000X 349 AZ

Addresses

Primary practice location

2680 S Val Vista Dr
Suite 111
Gilbert, AZ 85295-1606

Mailing address

2680 S Val Vista Dr
Suite 111
Gilbert, AZ 85295-1606
Phone (480) 807-0288

Other identifiers 1

IdentifierTypeStateIssuer
0917440001OtherAZDMERC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080521000369 AZ Part B Supplier - Clinic/Group Practice 1456420140 Receives reassigned benefits from 5 practitioners
Practice locations: Gilbert, AZ

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1198713600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1331078400000",
    "number": "1114101136",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2680 S VAL VISTA DR",
            "address_2": "SUITE 111",
            "city": "GILBERT",
            "state": "AZ",
            "postal_code": "852951606",
            "telephone_number": "480-807-0288",
            "fax_number": "480-290-7199"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2680 S VAL VISTA DR",
            "address_2": "SUITE 111",
            "city": "GILBERT",
            "state": "AZ",
            "postal_code": "852951606",
            "telephone_number": "480-807-0288",
            "fax_number": "480-290-7199"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAN TAN EYECARE PLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-12-27",
        "last_updated": "2012-03-07",
        "status": "A",
        "authorized_official_last_name": "HOSTETLER",
        "authorized_official_first_name": "JACK",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "480-807-0288",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": "AZ",
            "license": "1307",
            "primary": true
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": "AZ",
            "license": "349",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DMERC",
            "identifier": "0917440001",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Gilbert, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.