Eye Center Optometrics, a Professional Corporation
Organization Active NPI Optometrist · Rocklin, CA
NPI 1275869166 · NPPES record last updated Mar 31, 2014
Key facts
- NPI
- 1275869166
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Optometrist 152W00000X
- License
- BOL6464 (CA)
- Legal business name
- EYE CENTER OPTOMETRICS, A PROFESSIONAL CORPORATION
- Practice address
- 6809 Five Star Blvd
Suite #100a
Rocklin, CA 95677-2687 - Phone
- (916) 624-2020
- Fax
- (916) 624-3027
- NPI assigned
- Oct 27, 2009
- Organization subpart
- No
Authorized official
- Name
- Lori L Cooper
- Title
- Communications Director
- Phone
- (916) 726-1818
Other NPIs on the same Medicare enrollment 3
Corporate family (same tax ID) 4
Practitioners 14
-
German Aparicio, OD
-
Melissa Bersamina, O.D.
-
Brenda S Coen, O.D.
-
Scott E Gittins, O.D.
-
Adam Glover, O.D.
-
Palmer N Lee, O.D.
-
Gyneth Rock, OD
-
Jansen John Coen, OD
-
John C Coen, O.D.
-
Randall F Fuerst, O.D.
-
Mahnoush Rafat, OD
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040924000851 | CA | Part B Supplier - Clinic/Group Practice | 4385613595 |
Receives reassigned benefits from 28 practitioners 3 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Citrus Heights, CA; Folsom, CA; Gold River, CA; Rocklin, CA; Sacramento, CA |
National Provider Directory
- Tax ID family
- Eye Center Optometrics Apc
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist |
152W00000X | BOL6464 | CA | Yes |
Addresses
Primary practice location
6809 Five Star Blvd
Suite #100a
Rocklin, CA 95677-2687
Mailing address
5959 Greenback LN
Suite 130
Citrus Heights, CA 95621-4700
Phone (916) 726-1818
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| GSD001122 | Medicaid | CA | |
| ZZZ50557Z | Other | CA | BCBS |
Other providers in Rocklin, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 31, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.