Individual provider Active NPI

Charles Huston Daily, OD

  • Optometrist
  • Modesto, CA
National Provider Identifier
1295726875
Registry record updated Sep 6, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
4909TPO Issued in CA
Practice address
1401 Sylvan Ave
Modesto, CA 95355-1367
Phone
(209) 527-6640
Fax
(209) 527-5489
NPI assigned
Nov 2, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 6, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 4909TPO CA Primary

Addresses

Primary practice location

1401 Sylvan Ave
Modesto, CA 95355-1367

Mailing address

1401 Sylvan Ave
Modesto, CA 95355-1367
Phone (209) 527-6640

Other identifiers 1

IdentifierTypeStateIssuer
12460OtherCAMEDICAL EYE SERVICES

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
Eligible to order & refer
  • Part B services: No
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
4909CAMDMental Health Counselor
4909TPOCAMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Kennedy & Young Optometry Optometrist PastSince Jun 22, 2021 Accepting new patients

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.

NPI Registry JSON

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

{
    "created_epoch": "1130889600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1346889600000",
    "number": "1295726875",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1401 SYLVAN AVE",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953551367",
            "telephone_number": "209-527-6640",
            "fax_number": "209-527-5489"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1401 SYLVAN AVE",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953551367",
            "telephone_number": "209-527-6640",
            "fax_number": "209-527-5489"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAILY",
        "first_name": "CHARLES",
        "middle_name": "HUSTON",
        "name_prefix": "Mr.",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-11-02",
        "last_updated": "2012-09-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "4909TPO",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL EYE SERVICES",
            "identifier": "12460",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Modesto, CA

Sources for this page

Verify at the official NPI Registry.