Organization Active NPI

Ben Palmer, O.D. a Professional Optometric Corporation

Doing business as Nipomo Optometry

  • Optometrist
  • Nipomo, CA
National Provider Identifier
1346539095
Registry record updated Dec 21, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
13794 TLG Issued in CA
Legal business name
BEN PALMER, O.D. A PROFESSIONAL OPTOMETRIC CORPORATION
Doing business as
Nipomo Optometry
Practice address
150 S Mary Ave Ste 4
Nipomo, CA 93444-7821
Phone
(805) 929-1982
Fax
(805) 929-5052
NPI assigned
Apr 4, 2011
Last updated
Dec 21, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 21, 2024

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

Authorized official

Name
Dr. Ben C Palmer, O.D.NPI 1235463944
Title
Optometrist
Phone
(805) 929-1982

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 13794 TLG CA Primary

Addresses

Primary practice location

150 S Mary Ave Ste 4
Nipomo, CA 93444-7821

Mailing address

150 S Mary Ave Ste 4
Nipomo, CA 93444-7821
Phone (805) 929-1982

Other names 1

  • Nipomo Optometry Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110913000407 CA Part B Supplier - Clinic/Group Practice 2163690389 Receives reassigned benefits from 1 practitioner
Practice locations: Nipomo, CA

National Provider Directory

National Provider Directory

Locations

125 S Frontage Rd
Nipomo, CA 93444
Phone (805) 550-8579

150 Mary Ave
#4
Nipomo, CA 93444

150 Mary Ave
Ste 45
Nipomo, CA 93444
Phone (805) 929-1982

150 S Mary Ave
Ste 4
Nipomo, CA 93444
Phone (805) 929-1982

Practitioners & affiliated clinicians

Practitioners 2

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": "1301875200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1734739200000",
    "number": "1346539095",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "150 S MARY AVE STE 4",
            "city": "NIPOMO",
            "state": "CA",
            "postal_code": "934447821",
            "telephone_number": "805-929-1982",
            "fax_number": "805-929-5052"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "150 S MARY AVE STE 4",
            "city": "NIPOMO",
            "state": "CA",
            "postal_code": "934447821",
            "telephone_number": "805-929-1982",
            "fax_number": "805-929-5052"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BEN PALMER, O.D. A PROFESSIONAL OPTOMETRIC CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-04-04",
        "last_updated": "2024-12-21",
        "certification_date": "2024-12-21",
        "status": "A",
        "authorized_official_last_name": "PALMER",
        "authorized_official_first_name": "BEN",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "OPTOMETRIST",
        "authorized_official_telephone_number": "805-929-1982",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "13794 TLG",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Nipomo Optometry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Nipomo, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 21, 2024; 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.