Mark William Waldmire

Primary specialty

OptometristTaxonomy code 152W00000X

License

10098T Issued in CA

Practice address

4633 Whitney Ave
Suite a
Sacramento, CA 95821-4100

Phone

(916) 487-1717

Fax

(916) 487-3081

NPI assigned

Aug 17, 2005

Last updated

Feb 23, 2015By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Optometry

Education

University of California - School of Optometry, 1993

Medicare assignment

May accept Medicare assignment

Group practices

Eye 2 Eye Family Optometry PCGroup PAC ID 5799945317, 2 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Eye 2 Eye Family Optometry, PC

  • Optometrist
  • North Highlands, CA
  • NPI 1629348313
  Medicare reassignment Care Compare group NPD
• Eye 2 Eye Family Optometry, P.C.

  • Optometrist
  • Sacramento, CA
  • NPI 1225301898
  NPD Authorized official

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

{
    "created_epoch": "1124236800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1424649600000",
    "number": "1154313963",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4633 WHITNEY AVE",
            "address_2": "SUITE A",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958214100",
            "telephone_number": "916-487-1717"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4633 WHITNEY AVE",
            "address_2": "SUITE A",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958214100",
            "telephone_number": "916-487-1717",
            "fax_number": "916-487-3081"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALDMIRE",
        "first_name": "MARK",
        "middle_name": "WILLIAM",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-08-17",
        "last_updated": "2015-02-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "10098T",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "SD0100980",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ben Waldau, M.D.
• Alfred Freeman. Walden, D.D.S.
• Lauren Marie Walden, MD
• Ina Walder
• Sarah Waldman, M.D.
• Nicholas Waldon
• Ava Alexandra Waldrop
• Eric Robert Waldvogel
• Waleed Soliman Dental Corp (Brite Dental Group)
• Donna D. Walgenbach, M.S.

• Optometrist in Sacramento, CA
• Providers in Sacramento, CA by specialty
• Optometrist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 23, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.