Active NPI
Mohamed Ajaz Siddiqui, O.D.
- Optometrist
- Fremont, CA
National Provider Identifier
1306072699
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 12465
- Practice address
- 4812 Mendocino Ter
Fremont, CA 94555-2834 - Phone
- (510) 468-7708
- NPI assigned
- Jun 1, 2009
- Last updated
- Jun 1, 2009
- Sex
- Male
- 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 | 12465 | CA | Primary |
Addresses
Primary practice location
4812 Mendocino Ter
Fremont, CA 94555-2834
Mailing address
4812 Mendocino Ter
Fremont, CA 94555-2834
Phone (510) 468-7708
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 |
|---|---|---|---|---|
| I20091008000498 | CA | Practitioner - Optometry | 6507902327 | Practice locations: Rohnert Park, CA |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 12465 | CA | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1243814400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1243814400000",
"number": "1306072699",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4812 MENDOCINO TER",
"city": "FREMONT",
"state": "CA",
"postal_code": "945552834",
"telephone_number": "510-468-7708"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4812 MENDOCINO TER",
"city": "FREMONT",
"state": "CA",
"postal_code": "945552834",
"telephone_number": "510-468-7708"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SIDDIQUI",
"first_name": "MOHAMED",
"middle_name": "AJAZ",
"name_prefix": "Dr.",
"credential": "O.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2009-06-01",
"last_updated": "2009-06-01",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "CA",
"license": "12465",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fremont, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 1, 2009; 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.