NPIMap

Organization Active NPI

Center for Sight of Stockton a Medical Corporation

  • Specialist
  • Stockton, CA
National Provider Identifier
1326062084
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
Legal business name
CENTER FOR SIGHT OF STOCKTON A MEDICAL CORPORATION
Practice address
1899 W March LN
Stockton, CA 95207-6402
Phone
(209) 623-4700
Fax
(209) 623-4713
NPI assigned
Jul 27, 2006
Last updated
Jul 21, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Authorized official

Name
Philip A Edington, MDNPI 1508837279
Title
Director
Phone
(209) 948-5515

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
Specialist 174400000X NU Primary

Addresses

Primary practice location

1899 W March LN
Stockton, CA 95207-6402

Mailing address

1899 W. March Lane
Stockton, CA 95207-6402
Phone (209) 623-4700

Other practice location 1

1805 N California St
Suite 101
Stockton, CA 95204-6037
Phone (209) 948-5515

Other identifiers 1

IdentifierTypeStateIssuer
ZZZ70169ZOtherCAGROUP PTAN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20050714000703 CA Part B Supplier - Clinic/Group Practice 2264499037 Receives reassigned benefits from 4 practitioners
3 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Manteca, CA; Modesto, CA; Stockton, CA; Tracy, CA
O20100930066481 CA DME Supplier - Physician - Ophthalmology 2264499037 Practice locations: Stockton, CA

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 3

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

National Provider Directory

National Provider Directory

Locations

1208 E North St
#A
Manteca, CA 95336
Phone (209) 823-1152

1208 Floyd Ave
Ste D
Modesto, CA 95350
Phone (209) 622-2700

1425 W H St
Ste 340
Oakdale, CA 95361
Phone (209) 847-2780

612 W 11th St
Tracy, CA 95376
Phone (209) 834-2314

612 W 11th St
Ste 103
Tracy, CA 95376
Phone (209) 836-4800

Networks

  • BSC 65 PLUS INDIVIDUAL MAPDPlans: Blue Shield 65 Plus (HMO) (H0504-015-000, H0504); Blue Shield 65 Plus (HMO) (H0504-039-000, H0504); Blue Shield 65 Plus Plan 2 (HMO) (H0504-021-000, H0504); Blue Shield Inspire (HMO) (H0504-041-000, H0504); Blue Shield 65 Plus (HMO) (H0504-038-000, H0504); Blue Shield Inspire (HMO) (H0504-047-000, H0504); Blue Shield 65 Plus (HMO) (H0504-026-000, H0504); Blue Shield Advantage (HMO) (H0504-050-000, H0504); Blue Shield AdvantageOptimum Plan (HMO) (H5928-004-000, H5928); Blue Shield Inspire (HMO) (H0504-043-000, H0504)…

Practitioners & affiliated clinicians

Practitioners 11

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.

NPI Registry JSON

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

{
    "created_epoch": "1153958400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1326062084",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1899 W. MARCH LANE",
            "city": "STOCKTON",
            "state": "CA",
            "postal_code": "952076402",
            "telephone_number": "209-623-4700",
            "fax_number": "209-623-4713"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1899 W MARCH LN",
            "city": "STOCKTON",
            "state": "CA",
            "postal_code": "952076402",
            "telephone_number": "209-623-4700",
            "fax_number": "209-623-4713"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1805 N California St",
            "address_2": "SUITE 101",
            "address_purpose": "LOCATION",
            "city": "Stockton",
            "state": "CA",
            "postal_code": "952046037",
            "country_code": "US",
            "telephone_number": "209-948-5515",
            "fax_number": "209-948-9321",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "CENTER FOR SIGHT OF STOCKTON A MEDICAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-27",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "EDINGTON",
        "authorized_official_first_name": "PHILIP",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "209-948-5515",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP PTAN",
            "identifier": "ZZZ70169Z",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Stockton, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.