NPIMap

Organization Active NPI

Family Optometry of Tracy Inc

  • Vision Therapy Optometrist
  • Tracy, CA
National Provider Identifier
1154634236
Registry record updated Nov 2, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Vision Therapy OptometristTaxonomy code 152WV0400X
License
13351 TPL Issued in CA
Legal business name
FAMILY OPTOMETRY OF TRACY INC
Practice address
2104 W Grant Line Rd
Tracy, CA 95377-7309
Phone
(209) 229-8611
Fax
(209) 229-8559
NPI assigned
Jul 19, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 2, 2010

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

Authorized official

Name
Corinna Marie Shelley, ODNPI 1922281930
Title
Owner
Phone
(209) 229-8611

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Vision Therapy OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152WV0400X 13351 TPL CA Primary

Addresses

Primary practice location

2104 W Grant Line Rd
Tracy, CA 95377-7309

Mailing address

2104 W Grant Line Rd
Tracy, CA 95377-7309
Phone (209) 229-8611

National Provider Directory

National Provider Directory

Locations

2104 W Grant Line Rd
Tracy, CA 95377
Phone (209) 229-8611

Practitioners & affiliated clinicians

Practitioners 3

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": "1279497600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1288656000000",
    "number": "1154634236",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2104 W GRANT LINE RD",
            "city": "TRACY",
            "state": "CA",
            "postal_code": "953777309",
            "telephone_number": "209-229-8611",
            "fax_number": "209-229-8559"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2104 W GRANT LINE RD",
            "city": "TRACY",
            "state": "CA",
            "postal_code": "953777309",
            "telephone_number": "209-229-8611",
            "fax_number": "209-229-8559"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILY OPTOMETRY OF TRACY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-07-19",
        "last_updated": "2010-11-02",
        "status": "A",
        "authorized_official_last_name": "SHELLEY",
        "authorized_official_first_name": "CORINNA",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "209-229-8611",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152WV0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist, Vision Therapy",
            "state": "CA",
            "license": "13351 TPL",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tracy, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 2, 2010; 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.