Active NPI
Pamela L. Puccinelli, O.D.
- Optometrist
- Antioch, CA
National Provider Identifier
1285602904
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 9548T
- Practice address
- 3436 Hillcrest Ave
Suite 100
Antioch, CA 94531-6304 - Phone
- (925) 778-5688
- Fax
- (925) 778-8708
- NPI assigned
- Mar 9, 2006
- Last updated
- Apr 29, 2014
- Sex
- Female
- Sole proprietor
- Yes
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 | 9548T | CA | Primary |
Addresses
Primary practice location
3436 Hillcrest Ave
Suite 100
Antioch, CA 94531-6304
Mailing address
3436 Hillcrest Ave
Suite 100
Antioch, CA 94531-6304
Phone (925) 778-5688
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 |
|---|---|---|---|---|
| I20040405001260 | CA | Practitioner - Optometry | 8426041674 | Practice locations: Antioch, CA |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 9548 | CA | MD | Mental Health Counselor |
| 9548T | CA | MD | Optometrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1141862400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1398729600000",
"number": "1285602904",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3436 HILLCREST AVE",
"address_2": "SUITE 100",
"city": "ANTIOCH",
"state": "CA",
"postal_code": "945316304",
"telephone_number": "925-778-5688",
"fax_number": "925-778-8708"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3436 HILLCREST AVE",
"address_2": "SUITE 100",
"city": "ANTIOCH",
"state": "CA",
"postal_code": "945316304",
"telephone_number": "925-778-5688",
"fax_number": "925-778-8708"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PUCCINELLI",
"first_name": "PAMELA",
"middle_name": "L.",
"name_prefix": "Dr.",
"credential": "O.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-03-09",
"last_updated": "2014-04-29",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "CA",
"license": "9548T",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Antioch, CA
- Provident Vision Network, Inc. (Open Arms Safe Haven Trauma Recovery Centers)
- Renata Lima Provost, CD(DONA)
- John Pryor
- Psychotherapy Institute of Individual, Family & Community Development
- Nicole Fay Ptak
- Valerie Purdey
- Kalei Pututau
- Syed A. a. Qadri, MD
- Natasha Lynn Quackenbush, PSY.D.
- Clifford Quan, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 29, 2014; 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.