NPIMap

Organization Active NPI

Stanford Optical Shop

  • Optician
  • Palo Alto, CA
National Provider Identifier
1174735963
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
OpticianTaxonomy code 156FX1800X
License
SL 4881 Issued in CA
Legal business name
STANFORD OPTICAL SHOP
Practice address
900 Blake Wilbur Dr RM W1090
Palo Alto, CA 94304-2201
Phone
(650) 736-0566
Fax
(650) 736-0575
NPI assigned
May 4, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Ms. Judy Regalado, ABOC
Title
Licensed Optician
Phone
(650) 736-0566

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OpticianGroup: 193400000X SINGLE SPECIALTY GROUP 156FX1800X SL 4881 CA Primary

Addresses

Primary practice location

900 Blake Wilbur Dr RM W1090
Palo Alto, CA 94304-2201

Mailing address

900 Blake Wilbur Dr.
Room W1090
Palo Alto, CA 94304-1185
Phone (650) 736-0566

Other names 1

  • Stanford Hospital and Clinics Other name

National Provider Directory

National Provider Directory
Tax ID family
UCSF Stanfordhealth Car50 organizations share this tax ID, including this one

Other organizations with this tax ID 49

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

View all 49

Locations

900 Blake Wilbur Dr
Rm W1090
Palo Alto, CA 94304
Phone (650) 736-0566

NPI Registry JSON

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

{
    "created_epoch": "1178236800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1174735963",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "900 BLAKE WILBUR DR.",
            "address_2": "ROOM W1090",
            "city": "PALO ALTO",
            "state": "CA",
            "postal_code": "943041185",
            "telephone_number": "650-736-0566",
            "fax_number": "650-736-0575"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "900 BLAKE WILBUR DR RM W1090",
            "city": "PALO ALTO",
            "state": "CA",
            "postal_code": "943042201",
            "telephone_number": "650-736-0566",
            "fax_number": "650-736-0575"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STANFORD OPTICAL SHOP",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-04",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "REGALADO",
        "authorized_official_first_name": "JUDY",
        "authorized_official_title_or_position": "LICENSED OPTICIAN",
        "authorized_official_telephone_number": "650-736-0566",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "ABOC"
    },
    "taxonomies": [
        {
            "code": "156FX1800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Technician/Technologist, Optician",
            "state": "CA",
            "license": "SL 4881",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Stanford Hospital and Clinics",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Palo Alto, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.