Individual provider Active NPI

Kevin M Trainor

  • Optometrist
  • San Jose, CA
National Provider Identifier
1215902341
Registry record updated Jan 2, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
CA9452T Issued in CA
Practice address
1172 Lincoln Ave
San Jose, CA 95125
Phone
(408) 283-7100
Fax
(408) 283-7103
NPI assigned
Feb 22, 2006
Last updated
Jan 2, 2008By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 2, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X CA9452T CA Primary

Addresses

Primary practice location

1172 Lincoln Ave
San Jose, CA 95125

Mailing address

1172 Lincoln Ave
San Jose, CA 95125
Phone (408) 283-7100

Other identifiers 2

IdentifierTypeStateIssuer
ZZZ05960ZOtherCAGROUP PTAN
SD0094520OtherCAINDIVIDUAL PTAN

Other names 1

  • Dr. Kevin M Trainor Professional name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20080528000407 CA Practitioner - Optometry 3577653336 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
CA9452TCAMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Trainor & Ngan Professional Optometric Corporation Optometrist CurrentSince Jul 1, 2007 Accepting new patients
Visual Eyes Optometrist PastSince Jul 1, 2007 Accepting new patients

Locations

1172 Lincoln Ave
San Jose, CA 95125
Phone (408) 283-7100

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1140566400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1199232000000",
    "number": "1215902341",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1172 LINCOLN AVE",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "95125",
            "telephone_number": "408-283-7100",
            "fax_number": "408-283-7103"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1172 LINCOLN AVE",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "95125",
            "telephone_number": "408-283-7100",
            "fax_number": "408-283-7103"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TRAINOR",
        "first_name": "KEVIN",
        "middle_name": "M",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-22",
        "last_updated": "2008-01-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "CA9452T",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP PTAN",
            "identifier": "ZZZ05960Z",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INDIVIDUAL PTAN",
            "identifier": "SD0094520",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KEVIN",
            "last_name": "TRAINOR",
            "middle_name": "M",
            "prefix": "DR.",
            "credential": "OD",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

Other providers in San Jose, CA

Sources for this page

Verify at the official NPI Registry.