Active NPI
Robert Lytton Hetland, M.D.
- Ophthalmology Physician
- San Carlos, CA
National Provider Identifier
1174558985
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Ophthalmology Physician
- License
- A22540
- Practice address
- 1395 San Carlos Ave
Suite a
San Carlos, CA 94070-2388 - Phone
- (650) 802-9921
- Fax
- (650) 802-9923
- NPI assigned
- Jul 11, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Ophthalmology Physician | 207W00000X | A22540 | CA | Primary |
Addresses
Primary practice location
1395 San Carlos Ave
Suite a
San Carlos, CA 94070-2388
Mailing address
1395 San Carlos Ave
Suite a
San Carlos, CA 94070-2388
Phone (650) 802-9921
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 11002645 | Other | CA | CAQH PROVIDER ID |
| 4056691 | Other | CA | AETNA ID |
| 00A225400 | Medicaid | CA | |
| P00205050 | Other | CA | RAILROAD MEDICARE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Ninh Huy Tran, M.D., Inc. | Ophthalmology | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Ophthalmology Physician
- San Carlos, CA
- NPI 1922208529
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1152576000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1466553600000",
"number": "1174558985",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1395 SAN CARLOS AVE",
"address_2": "SUITE A",
"city": "SAN CARLOS",
"state": "CA",
"postal_code": "940702388",
"telephone_number": "650-802-9921",
"fax_number": "650-802-9923"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1395 SAN CARLOS AVE",
"address_2": "SUITE A",
"city": "SAN CARLOS",
"state": "CA",
"postal_code": "940702388",
"telephone_number": "650-802-9921",
"fax_number": "650-802-9923"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HETLAND",
"first_name": "ROBERT",
"middle_name": "LYTTON",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-07-11",
"last_updated": "2016-06-22",
"status": "A"
},
"taxonomies": [
{
"code": "207W00000X",
"taxonomy_group": "",
"desc": "Ophthalmology",
"state": "CA",
"license": "A22540",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CAQH PROVIDER ID",
"identifier": "11002645",
"state": "CA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA ID",
"identifier": "4056691",
"state": "CA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00A225400",
"state": "CA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "P00205050",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in San Carlos, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 22, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.