NPIMap

Organization Active NPI

First Optometric Care of Northern California PC

Doing business as Stanislaus Optometric Center Inc

  • Optometrist
  • Modesto, CA
National Provider Identifier
1164017646
Registry record updated Mar 11, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
Legal business name
FIRST OPTOMETRIC CARE OF NORTHERN CALIFORNIA PC
Doing business as
Stanislaus Optometric Center Inc
Practice address
4028 Dale Rd
Modesto, CA 95356-9561
Phone
(209) 791-8001
NPI assigned
Mar 5, 2021
Last updated
Mar 11, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 11, 2021

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

Authorized official

Name
Richard Brian McPherson
Title
Director of Operations
Phone
(916) 407-7156

Specialties & licenses 1

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

Addresses

Primary practice location

4028 Dale Rd
Modesto, CA 95356-9561

Mailing address

4028 Dale Rd
Modesto, CA 95356-9561
Phone (209) 791-8001

Other names 1

  • Stanislaus Optometric Center Inc Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210608000773 CA Part B Supplier - Clinic/Group Practice 6002216488 Receives reassigned benefits from 26 practitioners
13 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Cupertino, CA; Fair Oaks, CA; Modesto, CA; Norwalk, CA; Palo Alto, CA; Pinole, CA; Rancho Cordova, CA; Redwood City, CA…

Other NPIs on the same Medicare enrollment 12

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Brookside Optometric Group12 organizations share this tax ID, including this one

Other organizations with this tax ID 11

Organizations that report the same tax identification number in the National Provider Directory.

Locations

4028 Dale Rd
Modesto, CA 95356
Phone (209) 791-8001

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1614902400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1615420800000",
    "number": "1164017646",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4028 DALE RD",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953569561",
            "telephone_number": "209-791-8001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4028 DALE RD",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953569561",
            "telephone_number": "209-791-8001"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FIRST OPTOMETRIC CARE OF NORTHERN CALIFORNIA PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-03-05",
        "last_updated": "2021-03-11",
        "certification_date": "2021-03-11",
        "status": "A",
        "authorized_official_last_name": "MCPHERSON",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_middle_name": "BRIAN",
        "authorized_official_title_or_position": "DIRECTOR OF OPERATIONS",
        "authorized_official_telephone_number": "916-407-7156"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Stanislaus Optometric Center Inc",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Stanislaus Optometric Center Inc",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Modesto, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.