NPIMap

Organization Active NPI

Corydon G Edgecomb OD Inc

  • Optometrist
  • Placerville, CA
National Provider Identifier
1225334683
Registry record updated Mar 21, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
OPT 4245 TPA Issued in CA
Legal business name
CORYDON G EDGECOMB OD INC
Practice address
1287 Broadway
Placerville, CA 95667-5820
Phone
(530) 622-7660
Fax
(530) 622-3753
NPI assigned
Feb 2, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 21, 2011

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

Authorized official

Name
Dr. Corydon Edgecomb, O.D.
Title
Doctor
Phone
(530) 622-7660

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X OPT 4245 TPA CA Primary

Addresses

Primary practice location

1287 Broadway
Placerville, CA 95667-5820

Mailing address

1287 Broadway
Placerville, CA 95667-5820
Phone (530) 622-7660

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

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": "1296604800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1300665600000",
    "number": "1225334683",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1287 BROADWAY",
            "city": "PLACERVILLE",
            "state": "CA",
            "postal_code": "956675820",
            "telephone_number": "530-622-7660",
            "fax_number": "530-622-3753"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1287 BROADWAY",
            "city": "PLACERVILLE",
            "state": "CA",
            "postal_code": "956675820",
            "telephone_number": "530-622-7660",
            "fax_number": "530-622-3753"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CORYDON G EDGECOMB OD INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-02-02",
        "last_updated": "2011-03-21",
        "status": "A",
        "authorized_official_last_name": "EDGECOMB",
        "authorized_official_first_name": "CORYDON",
        "authorized_official_title_or_position": "DOCTOR",
        "authorized_official_telephone_number": "530-622-7660",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "CA",
            "license": "OPT 4245 TPA",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Placerville, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 21, 2011; 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.