Active NPI
Mathirmedha Mangipudi
- Optometrist
- Pleasanton, CA
National Provider Identifier
1275359200
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- OPT35855-TLG
- Practice address
- 7200 Johnson Dr
Pleasanton, CA 94588-8005 - Phone
- (925) 998-8753
- NPI assigned
- Nov 25, 2024
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | OPT35855-TLG | CA | Primary |
Addresses
Primary practice location
7200 Johnson Dr
Pleasanton, CA 94588-8005
Mailing address
7200 Johnson Dr
Pleasanton, CA 94588-8005
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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20250625004325 | CA | Practitioner - Optometry | 3274045018 | Practice locations: Pleasanton, CA |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| OPT35855-TLG | CA | MD | Optometrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| MM Optometric Corporation | Optometrist | Current | Accepting new patients |
Locations
3024 W Jack London Blvd
Livermore, CA 94551
Phone (925) 800-5149
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Optometrist
- Livermore, CA
- NPI 1720877822
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1732492800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1734652800000",
"number": "1275359200",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7200 JOHNSON DR",
"city": "PLEASANTON",
"state": "CA",
"postal_code": "945888005"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7200 JOHNSON DR",
"city": "PLEASANTON",
"state": "CA",
"postal_code": "945888005",
"telephone_number": "925-998-8753"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MANGIPUDI",
"first_name": "MATHIRMEDHA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2024-11-25",
"last_updated": "2024-12-20",
"certification_date": "2024-12-20",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "CA",
"license": "OPT35855-TLG",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Pleasanton, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 20, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.