NPIMap

Organization Active NPI

Eyecenter Optometrics, a Professional Corporation

  • Optometrist
  • Gold River, CA
National Provider Identifier
1346576295
Registry record updated Mar 31, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
BOL6465 Issued in CA
Legal business name
EYECENTER OPTOMETRICS, A PROFESSIONAL CORPORATION
Practice address
2200 Sunrise Blvd
Suite #120
Gold River, CA 95670-4374
Phone
(916) 852-1600
Fax
(916) 852-0231
NPI assigned
Oct 28, 2009
Organization subpart
No

Authorized official

NPPES NPI Registry
Name
Lori L Cooper
Title
Communications Director
Phone
(916) 726-1818

Other NPIs on the same Medicare enrollment 3

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

Corporate family (same tax ID) 4

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners 29

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 29

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040924000851 CA Part B Supplier - Clinic/Group Practice 4385613595 Receives reassigned benefits from 28 practitioners
3 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Citrus Heights, CA; Folsom, CA; Gold River, CA; Rocklin, CA; Sacramento, CA

National Provider Directory

National Provider Directory
Tax ID family
Eye Center Optometrics Apc (5 organizations share this tax ID)

Locations

421 Blue Ravine Rd
Ste 300
Folsom, CA 95630
Phone (916) 452-4706

Specialties & licenses 1

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193200000X MULTI-SPECIALTY GROUP 152W00000X BOL6465 CA Primary

Addresses

NPPES NPI Registry

Primary practice location

2200 Sunrise Blvd
Suite #120
Gold River, CA 95670-4374

Mailing address

5959 Greenback LN
Suite # 130
Citrus Heights, CA 95621-9562
Phone (916) 852-1600

Other identifiers 2

NPPES NPI Registry
IdentifierTypeStateIssuer
ZZZ50558ZOtherBCBS
GSD001121MedicaidCA

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Mar 31, 2014.

{
    "created_epoch": "1256688000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1396224000000",
    "number": "1346576295",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5959 GREENBACK LN",
            "address_2": "SUITE # 130",
            "city": "CITRUS HEIGHTS",
            "state": "CA",
            "postal_code": "956219562",
            "telephone_number": "916-852-1600",
            "fax_number": "916-852-0231"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2200 SUNRISE BLVD",
            "address_2": "SUITE #120",
            "city": "GOLD RIVER",
            "state": "CA",
            "postal_code": "956704374",
            "telephone_number": "916-852-1600",
            "fax_number": "916-852-0231"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EYECENTER OPTOMETRICS, A PROFESSIONAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-10-28",
        "last_updated": "2014-03-31",
        "status": "A",
        "authorized_official_last_name": "COOPER",
        "authorized_official_first_name": "LORI",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "COMMUNICATIONS DIRECTOR",
        "authorized_official_telephone_number": "916-726-1818"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": "CA",
            "license": "BOL6465",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "ZZZ50558Z",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GSD001121",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Gold River, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 31, 2014; 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.