Active NPI
Edith C Livelo, ABOC, RDO
- Optician
- San Mateo, CA
National Provider Identifier
1316010960
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optician
- License
- D 6765
- Practice address
- 21 S San Mateo Dr
San Mateo, CA 94401-3803 - Phone
- (650) 343-5151
- Fax
- (650) 343-5178
- NPI assigned
- Nov 15, 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optician | 156FX1800X | D 6765 | CA | Primary |
Addresses
Primary practice location
21 S San Mateo Dr
San Mateo, CA 94401-3803
Mailing address
21 S San Mateo Dr
San Mateo, CA 94401-3803
Phone (650) 343-5151
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| DX006765F | Medicaid | CA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| D 6765 | CA | MD | Optician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1163548800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1316010960",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "21 S SAN MATEO DR",
"city": "SAN MATEO",
"state": "CA",
"postal_code": "944013803",
"telephone_number": "650-343-5151",
"fax_number": "650-343-5178"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "21 S SAN MATEO DR",
"city": "SAN MATEO",
"state": "CA",
"postal_code": "944013803",
"telephone_number": "650-343-5151",
"fax_number": "650-343-5178"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LIVELO",
"first_name": "EDITH",
"middle_name": "C",
"credential": "ABOC, RDO",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-11-15",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "156FX1800X",
"taxonomy_group": "",
"desc": "Technician/Technologist, Optician",
"state": "CA",
"license": "D 6765",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "DX006765F",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in San Mateo, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.