East Bay Retina Consultants a Medical Group, Inc.

Primary specialty

Ophthalmology PhysicianTaxonomy code 207W00000X

License

A44312 Issued in CA

Legal business name

EAST BAY RETINA CONSULTANTS A MEDICAL GROUP, INC.

Practice address

3300 Webster St
Suite 1110
Oakland, CA 94609-3117

Phone

(510) 444-1600

Fax

(510) 444-5117

NPI assigned

Aug 29, 2005

Organization subpart

No

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

Authorized official

Name

Soon T Lee, M.D.

Title

Corporate Vice President

Phone

(510) 444-1600

Specialties & licenses 1

Addresses

Other names 1

• East Bay Retina Consultants, Inc. Doing business as

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Other NPIs on the same Medicare enrollment 6

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

• East Bay Retina Consultants a Medical Group, Inc

  • Ophthalmology Physician
  • Concord, CA
  • NPI 1477857886

  O20050330001058

  Same enrollment
• East Bay Retina Consultants a Medical Group, Inc.

  • Ophthalmology Physician
  • Concord, CA
  • NPI 1124319959

  O20050330001058

  Same enrollment
• East Bay Retina Consultants a Medical Group, Inc.

  • Ophthalmology Physician
  • Fremont, CA
  • NPI 1487690574

  O20050330001058

  Same enrollment
• East Bay Retina Consultants a Medical Group, Inc.

  • Ophthalmology Physician
  • San Ramon, CA
  • NPI 1578509667

  O20050330001058

  Same enrollment
• East Bay Retina Consultants a Medical Group, Inc.

  • Ophthalmology Physician
  • Pleasanton, CA
  • NPI 1679855076

  O20050330001058

  Same enrollment
• East Bay Retina Consultants a Medical Group, Inc.

  • Ophthalmology Physician
  • Oakland, CA
  • NPI 1790965341

  O20050330001058

  Same enrollment

Locations

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

{
    "created_epoch": "1125273600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1456704000000",
    "number": "1326031907",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3300 TELEGRAPH AVE",
            "city": "OAKLAND",
            "state": "CA",
            "postal_code": "946093028",
            "telephone_number": "510-444-1600",
            "fax_number": "510-444-5117"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3300 WEBSTER ST",
            "address_2": "SUITE 1110",
            "city": "OAKLAND",
            "state": "CA",
            "postal_code": "946093117",
            "telephone_number": "510-444-1600",
            "fax_number": "510-444-5117"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAST BAY RETINA CONSULTANTS A MEDICAL GROUP, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-08-29",
        "last_updated": "2016-02-29",
        "status": "A",
        "authorized_official_last_name": "LEE",
        "authorized_official_first_name": "SOON",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "CORPORATE VICE PRESIDENT",
        "authorized_official_telephone_number": "510-444-1600",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Ophthalmology",
            "state": "CA",
            "license": "A44312",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "East Bay Retina Consultants, Inc.",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• East Bay Special Imaging
• East Bay Special Imaging Medical Group, Inc.
• East Bay Special Surgery LLC

• Ophthalmology Physician in Oakland, CA
• Providers in Oakland, CA by specialty
• Ophthalmology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 29, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.