NPIMap

Organization Active NPI

Robert Gonzalez OD Inc

Doing business as Lake Murray Optometric Center

  • Optometrist
  • San Diego, CA
National Provider Identifier
1346673795
Registry record updated Oct 30, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
14343 Issued in CA
Legal business name
ROBERT GONZALEZ OD INC
Doing business as
Lake Murray Optometric Center
Practice address
8312 Lake Murray Blvd Ste C
San Diego, CA 92119-3435
Phone
(619) 464-2076
NPI assigned
Aug 20, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 30, 2014

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

Authorized official

Name
Dr. Robert Gonzalez, O.D.NPI 1295003614
Title
President
Phone
(619) 464-2076

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
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X 14343 CA Primary

Addresses

Primary practice location

8312 Lake Murray Blvd Ste C
San Diego, CA 92119-3435

Mailing address

8312 Lake Murray Blvd Ste C
San Diego, CA 92119-3435
Phone (619) 464-2076

Other names 1

  • Lake Murray Optometric Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20140313000613 CA Part B Supplier - Clinic/Group Practice 3678703618 Receives reassigned benefits from 4 practitioners
Practice locations: San Diego, CA

National Provider Directory

National Provider Directory

Locations

8312 Lake Murray Blvd
Ste C
San Diego, CA 92119
Phone (619) 464-2076

Practitioners & affiliated clinicians

Practitioners 5

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

NPI Registry JSON

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

{
    "created_epoch": "1376956800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1414627200000",
    "number": "1346673795",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8312 LAKE MURRAY BLVD STE C",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921193435",
            "telephone_number": "619-464-2076"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8312 LAKE MURRAY BLVD STE C",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921193435",
            "telephone_number": "619-464-2076"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROBERT GONZALEZ OD INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-08-20",
        "last_updated": "2014-10-30",
        "status": "A",
        "authorized_official_last_name": "GONZALEZ",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "619-464-2076",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "CA",
            "license": "14343",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lake Murray Optometric Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in San Diego, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 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.