Active NPI
Penelope Sholes Suter, O.D.
- Optometrist
- Bakersfield, CA
National Provider Identifier
1295834299
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 08128T
- Practice address
- 5300 California Ave Ste 210
Bakersfield, CA 93309-1642 - Phone
- (661) 869-2010
- Fax
- (661) 869-2708
- NPI assigned
- Sep 22, 2006
- 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 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Vision Therapy Optometrist | 152WV0400X | 08128T | CA | |
| Rehabilitation Practitioner | 225400000X | 08128T | CA | |
| Optometrist | 152W00000X | 08128T | CA | Primary |
Addresses
Primary practice location
5300 California Ave Ste 210
Bakersfield, CA 93309-1642
Mailing address
5300 California Ave Ste 210
Bakersfield, CA 93309-1642
Phone (661) 869-2010
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| GSD001690 | Medicaid | CA | |
| SD0081280 | Medicaid | CA |
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 |
|---|---|---|---|---|
| I20100517000353 | CA | Practitioner - Optometry | 6507763653 | Practice locations: Bakersfield, CA |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 08128T | CA | MD | Optometrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158883200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1517184000000",
"number": "1295834299",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5300 CALIFORNIA AVE STE 210",
"city": "BAKERSFIELD",
"state": "CA",
"postal_code": "933091642",
"telephone_number": "661-869-2010",
"fax_number": "661-869-2708"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5300 CALIFORNIA AVE STE 210",
"city": "BAKERSFIELD",
"state": "CA",
"postal_code": "933091642",
"telephone_number": "661-869-2010",
"fax_number": "661-869-2708"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SUTER",
"first_name": "PENELOPE",
"middle_name": "SHOLES",
"name_prefix": "Dr.",
"credential": "O.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-09-22",
"last_updated": "2018-01-29",
"status": "A"
},
"taxonomies": [
{
"code": "152WV0400X",
"taxonomy_group": "",
"desc": "Optometrist, Vision Therapy",
"state": "CA",
"license": "08128T",
"primary": false
},
{
"code": "225400000X",
"taxonomy_group": "",
"desc": "Rehabilitation Practitioner",
"state": "CA",
"license": "08128T",
"primary": false
},
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "CA",
"license": "08128T",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "GSD001690",
"state": "CA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "SD0081280",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Bakersfield, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 29, 2018; 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.