Eyedentity Vision Optometry, Inc.

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

License

12604 Issued in CA

Legal business name

EYEDENTITY VISION OPTOMETRY, INC.

Doing business as

Eyedentity Vision Optometry

Practice address

2786 Diamond St
San Francisco, CA 94131-3057

Phone

(415) 334-2020

Fax

(415) 681-9268

NPI assigned

Dec 9, 2007

Last updated

Oct 11, 2021By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Carrie Lee, O.D.NPI 1760474142

Title

President

Phone

(415) 334-2020

Specialties & licenses 1

Addresses

Other names 1

• Eyedentity Vision Optometry Doing business as

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Locations

Practitioners 3

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.

• Carrie Lee, O.D.

  • Optometrist
  • San Francisco, CA
  • NPI 1760474142
  Medicare reassignment Authorized official
• Anifa Avakian Stadtman, O.D.

  • Optometrist
  • Chandler, AZ
  • NPI 1396154456
  NPD (past)
• Mallory Nicole Lynch, O.D.

  • Optometrist
  • Austin, TX
  • NPI 1558674846
  NPD (past)

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

{
    "created_epoch": "1197158400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1633910400000",
    "number": "1255514642",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2786 DIAMOND ST",
            "city": "SAN FRANCISCO",
            "state": "CA",
            "postal_code": "941313057",
            "telephone_number": "415-334-2020",
            "fax_number": "415-681-9268"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2786 DIAMOND ST",
            "city": "SAN FRANCISCO",
            "state": "CA",
            "postal_code": "941313057",
            "telephone_number": "415-334-2020",
            "fax_number": "415-681-9268"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "601 Gateway Blvd Ste 220",
            "address_purpose": "LOCATION",
            "city": "South San Francisco",
            "state": "CA",
            "postal_code": "940807400",
            "country_code": "US",
            "telephone_number": "650-871-9200",
            "fax_number": "650-871-6026",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "EYEDENTITY VISION OPTOMETRY, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-12-09",
        "last_updated": "2021-10-11",
        "certification_date": "2021-10-11",
        "status": "A",
        "authorized_official_last_name": "LEE",
        "authorized_official_first_name": "CARRIE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "415-334-2020",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "CA",
            "license": "12604",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Eyedentity Vision Optometry",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Eyedentity Vision Optometry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Clinic/Center in San Francisco, CA
• Providers in San Francisco, CA by specialty
• Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 11, 2021; 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.