NPIMap

Organization Active NPI

Sierra Eyecare Associates

  • Optometrist
  • Valley Springs, CA
National Provider Identifier
1164594461
Registry record updated Aug 5, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
Legal business name
SIERRA EYECARE ASSOCIATES
Practice address
4 Jean St
Suite 1
Valley Springs, CA 95252-8867
Phone
(209) 772-9798
NPI assigned
Nov 14, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 5, 2009

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

Authorized official

Name
Duane Gibson, O.D.
Title
Owner
Phone
(209) 772-9798

Specialties & licenses 1

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

Addresses

Primary practice location

4 Jean St
Suite 1
Valley Springs, CA 95252-8867

Mailing address

4 Jean St
Suite 1
Valley Springs, CA 95252-8867
Phone (209) 772-9798

Other identifiers 2

IdentifierTypeStateIssuer
CP5166OtherCAMEDICARE RAILROAD
GSD005660MedicaidCA

Other names 1

  • Sierra Eyecare Associates, Valley Springs Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20050715001141 CA Part B Supplier - Clinic/Group Practice 2860449436 Receives reassigned benefits from 4 practitioners
Practice locations: Jackson, CA; Valley Springs, CA
O20100930099833 CA DME Supplier - Physician - OptometristDME Supplier - Optician 2860449436 Practice locations: Valley Springs, CA

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Sierra Eyecare Associates4 Jean St, Valley Springs, CA 95252-8867(209) 772-9798 Prosthetic Lenses: Conventional Eyeglasses|Prosthetic Lenses: Conventional Contact Lenses Accepts assignmentParticipating since Jul 1, 1998

National Provider Directory

National Provider Directory
Tax ID family
Sierra Eyecare Associat2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Practitioners & affiliated clinicians

Practitioners 4

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": "1163462400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1249430400000",
    "number": "1164594461",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4 JEAN ST",
            "address_2": "SUITE 1",
            "city": "VALLEY SPRINGS",
            "state": "CA",
            "postal_code": "952528867",
            "telephone_number": "209-772-9798"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4 JEAN ST",
            "address_2": "SUITE 1",
            "city": "VALLEY SPRINGS",
            "state": "CA",
            "postal_code": "952528867",
            "telephone_number": "209-772-9798"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SIERRA EYECARE ASSOCIATES",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-14",
        "last_updated": "2009-08-05",
        "status": "A",
        "authorized_official_last_name": "GIBSON",
        "authorized_official_first_name": "DUANE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "209-772-9798",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD",
            "identifier": "CP5166",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GSD005660",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Sierra Eyecare Associates, Valley Springs",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Valley Springs, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.