NPIMap

Organization Active NPI

Lake Merritt Optometry

  • Optometrist
  • Oakland, CA
National Provider Identifier
1134515679
Registry record updated Apr 11, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
11844T Issued in CA
Legal business name
LAKE MERRITT OPTOMETRY
Practice address
1807 3Rd Ave
Oakland, CA 94606-1803
Phone
(510) 444-1969
NPI assigned
Apr 11, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 11, 2015

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

Authorized official

Name
Dr. Serene Dawn Ngin, OD
Title
President
Phone
(510) 444-1969

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X 11844T CA Primary

Addresses

Primary practice location

1807 3Rd Ave
Oakland, CA 94606-1803

Mailing address

1807 3Rd Ave
Oakland, CA 94606-1803
Phone (510) 444-1969

National Provider Directory

National Provider Directory

Locations

1807 3rd Ave
Oakland, CA 94606
Phone (510) 444-1969

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": "1428710400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1428710400000",
    "number": "1134515679",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1807 3RD AVE",
            "city": "OAKLAND",
            "state": "CA",
            "postal_code": "946061803",
            "telephone_number": "510-444-1969"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1807 3RD AVE",
            "city": "OAKLAND",
            "state": "CA",
            "postal_code": "946061803",
            "telephone_number": "510-444-1969"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE MERRITT OPTOMETRY",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-04-11",
        "last_updated": "2015-04-11",
        "status": "A",
        "authorized_official_last_name": "NGIN",
        "authorized_official_first_name": "SERENE",
        "authorized_official_middle_name": "DAWN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "510-444-1969",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "CA",
            "license": "11844T",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Oakland, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 11, 2015; 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.