Organization Active NPI

Nelson & Endicott an Optometric Corporation

  • Optometrist
  • Rowland Heights, CA
National Provider Identifier
1134190853
Registry record updated Jul 27, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
6093T Issued in CA
Legal business name
NELSON & ENDICOTT AN OPTOMETRIC CORPORATION
Practice address
19735 Colima Rd
Rowland Heights, CA 91748-3227
Phone
(626) 912-1536
Fax
(909) 468-4603
NPI assigned
Jan 30, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 27, 2012

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

Authorized official

Name
Dr. John C Nelson, O.D.
Title
Owner
Phone
(626) 912-1536

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X 6093T CA Primary

Addresses

Primary practice location

19735 Colima Rd
Rowland Heights, CA 91748-3227

Mailing address

19735 Colima Rd
Rowland Heights, CA 91748-3227
Phone (626) 912-1536

Other identifiers 1

IdentifierTypeStateIssuer
GSD001240MedicaidCA

National Provider Directory

National Provider Directory

Locations

19735 Colima Rd
Rowland Heights, CA 91748
Phone (626) 912-1536

Practitioners & affiliated clinicians

Practitioners 1

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": "1138579200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1343347200000",
    "number": "1134190853",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19735 COLIMA RD",
            "city": "ROWLAND HEIGHTS",
            "state": "CA",
            "postal_code": "917483227",
            "telephone_number": "626-912-1536",
            "fax_number": "909-468-4603"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19735 COLIMA RD",
            "city": "ROWLAND HEIGHTS",
            "state": "CA",
            "postal_code": "917483227",
            "telephone_number": "626-912-1536",
            "fax_number": "909-468-4603"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NELSON & ENDICOTT AN OPTOMETRIC CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-01-30",
        "last_updated": "2012-07-27",
        "status": "A",
        "authorized_official_last_name": "NELSON",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "626-912-1536",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "CA",
            "license": "6093T",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GSD001240",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Rowland Heights, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 27, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.