NPIMap

Organization Active NPI

Larry R Fabian & Jeffrey M Fanelli PTRS Westside Family Vision Center

Doing business as Saratoga Vision Center

  • Optometrist
  • Saratoga, CA
National Provider Identifier
1255406690
Registry record updated Jun 7, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
BOL2584 Issued in CA
Legal business name
LARRY R FABIAN & JEFFREY M FANELLI PTRS WESTSIDE FAMILY VISION CENTER
Doing business as
Saratoga Vision Center
Practice address
18780 Cox Ave
Saratoga, CA 95070-4109
Phone
(408) 370-7303
Fax
(408) 370-7405
NPI assigned
Nov 21, 2006
Last updated
Jun 7, 2011By the provider in NPPES
Organization subpart
Yes
Parent organization
LARRY R FABIAN & JEFFREY M FANELLI PTRS WESTSIDE FAMILY VISION CENTERAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 7, 2011

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

Authorized official

Name
Ms. Nancy Le
Title
Optician
Phone
(408) 370-7303

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X BOL2584 CA Primary

Addresses

Primary practice location

18780 Cox Ave
Saratoga, CA 95070-4109

Mailing address

1817 Hamilton Ave
San Jose, CA 95125-5624
Phone (408) 264-1555

Other names 1

  • Saratoga Vision Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050808001188 CA Part B Supplier - Clinic/Group Practice 3072542273 Receives reassigned benefits from 5 practitioners
1 other NPI on this enrollment
Practice locations: San Jose, CA

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Larry R Fabian Jeffrey M F2 organizations share this tax ID, including this one
Part of
Larry R Fabian Jeffrey M F

Other organizations with this tax ID 1

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

Locations

1817 Hamilton Ave
San Jose, CA 95125
Phone (408) 264-1555

18780 Cox Ave
Saratoga, CA 95070
Phone (408) 370-7303

18800 Cox Ave
Saratoga, CA 95070

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1164067200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1307404800000",
    "number": "1255406690",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1817 HAMILTON AVE",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951255624",
            "telephone_number": "408-264-1555",
            "fax_number": "408-264-1562"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18780 COX AVE",
            "city": "SARATOGA",
            "state": "CA",
            "postal_code": "950704109",
            "telephone_number": "408-370-7303",
            "fax_number": "408-370-7405"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LARRY R FABIAN & JEFFREY M FANELLI PTRS WESTSIDE FAMILY VISION CENTER",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "LARRY R FABIAN & JEFFREY M FANELLI PTRS WESTSIDE FAMILY VISION CENTER",
        "enumeration_date": "2006-11-21",
        "last_updated": "2011-06-07",
        "status": "A",
        "authorized_official_last_name": "LE",
        "authorized_official_first_name": "NANCY",
        "authorized_official_title_or_position": "OPTICIAN",
        "authorized_official_telephone_number": "408-370-7303",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "BOL2584",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Saratoga Vision Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Saratoga, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 7, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.