Active NPI
Todd Randall Pickens, O.D.
- Optometrist
- Sutter Creek, CA
National Provider Identifier
1124088422
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 6317-T
- Practice address
- 10 Bryson Dr
Sutter Creek, CA 95685-4118 - Phone
- (209) 223-1402
- NPI assigned
- Mar 23, 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 | 6317-T | CA | Primary |
Addresses
Primary practice location
10 Bryson Dr
Sutter Creek, CA 95685-4118
Mailing address
10 Bryson Dr
Sutter Creek, CA 95685-4118
Phone (209) 223-1402
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| SD0063170 | 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 |
|---|---|---|---|
| 6317-T | CA | MD | Optometrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1143072000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1393372800000",
"number": "1124088422",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10 BRYSON DR",
"city": "SUTTER CREEK",
"state": "CA",
"postal_code": "956854118",
"telephone_number": "209-223-1402"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10 BRYSON DR",
"city": "SUTTER CREEK",
"state": "CA",
"postal_code": "956854118",
"telephone_number": "209-223-1402"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PICKENS",
"first_name": "TODD",
"middle_name": "RANDALL",
"credential": "O.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-03-23",
"last_updated": "2014-02-26",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "CA",
"license": "6317-T",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "SD0063170",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Sutter Creek, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 26, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.