NPIMap

Organization Active NPI

Advanced Eyecare Professional Optometric Group

  • Optometrist
  • Glendale, CA
National Provider Identifier
1306035118
Registry record updated Sep 21, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
OPT9869 Issued in CA
Legal business name
ADVANCED EYECARE PROFESSIONAL OPTOMETRIC GROUP
Practice address
330 N Brand Blvd
Suite 110
Glendale, CA 91203-2308
Phone
(818) 240-0890
Fax
(808) 246-2540
NPI assigned
Oct 17, 2007
Last updated
Sep 21, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 21, 2009

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

Authorized official

Name
Dr. Ronald V Black, O.D.NPI 1821032442
Title
Owner
Phone
(818) 240-0890

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X OPT9869 CA Primary

Addresses

Primary practice location

330 N Brand Blvd
Suite 110
Glendale, CA 91203-2308

Mailing address

330 N Brand Blvd
Suite 110
Glendale, CA 91203-2308
Phone (818) 240-0890

Other identifiers 1

IdentifierTypeStateIssuer
1306035118MedicaidCA

National Provider Directory

National Provider Directory

Locations

1055 Foothill Blvd
La Canada, CA 91011

Practitioners & affiliated clinicians

Practitioners 50

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 50

NPI Registry JSON

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

{
    "created_epoch": "1192579200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1253491200000",
    "number": "1306035118",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "330 N BRAND BLVD",
            "address_2": "SUITE 110",
            "city": "GLENDALE",
            "state": "CA",
            "postal_code": "912032308",
            "telephone_number": "818-240-0890",
            "fax_number": "808-246-2540"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "330 N BRAND BLVD",
            "address_2": "SUITE 110",
            "city": "GLENDALE",
            "state": "CA",
            "postal_code": "912032308",
            "telephone_number": "818-240-0890",
            "fax_number": "808-246-2540"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADVANCED EYECARE PROFESSIONAL OPTOMETRIC GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-17",
        "last_updated": "2009-09-21",
        "status": "A",
        "authorized_official_last_name": "BLACK",
        "authorized_official_first_name": "RONALD",
        "authorized_official_middle_name": "V",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "818-240-0890",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "OPT9869",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1306035118",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Glendale, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 21, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.