Individual provider Active NPI

Stanley Joseph Sadorf, O.D.

  • Optometrist
  • Victorville, CA
National Provider Identifier
1356420947
Registry record updated Dec 3, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
7329T Issued in CA
Practice address
14349 Amargosa Rd
Victorville, CA 92392-2317
Phone
(760) 241-2020
Fax
(760) 241-7925
NPI assigned
Nov 3, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 3, 2009

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 7329T CA Primary

Addresses

Primary practice location

14349 Amargosa Rd
Victorville, CA 92392-2317

Mailing address

14349 Amargosa Rd
Victorville, CA 92392-2317
Phone (760) 241-2020

Other identifiers 1

IdentifierTypeStateIssuer
13542607947MedicaidCA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
7329TCAMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
DRS Wells and Newton Optometrist PastSince Jul 17, 2009 Accepting new patients
Eyecee Optometric Inc Optometrist PastSince Oct 1, 2017 Accepting new patients

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1162512000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1259798400000",
    "number": "1356420947",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14349 AMARGOSA RD",
            "city": "VICTORVILLE",
            "state": "CA",
            "postal_code": "923922317",
            "telephone_number": "760-241-2020",
            "fax_number": "760-241-7925"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14349 AMARGOSA RD",
            "city": "VICTORVILLE",
            "state": "CA",
            "postal_code": "923922317",
            "telephone_number": "760-241-2020",
            "fax_number": "760-241-7925"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SADORF",
        "first_name": "STANLEY",
        "middle_name": "JOSEPH",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-03",
        "last_updated": "2009-12-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "7329T",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "13542607947",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Victorville, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 3, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.