NPIMap

Organization Active NPI

Elite Eyecare Medical Group a Medical Corporation

Doing business as Shepard Eye Center

  • Optometrist
  • Solvang, CA
National Provider Identifier
1356763759
Registry record updated Oct 1, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
OPT5812TPG Issued in CA
Legal business name
ELITE EYECARE MEDICAL GROUP A MEDICAL CORPORATION
Doing business as
Shepard Eye Center
Practice address
2040 Viborg Rd
#240
Solvang, CA 93463
Phone
(805) 688-0707
Fax
(805) 693-9839
NPI assigned
Jan 20, 2014
Last updated
Oct 1, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 1, 2018

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

Authorized official

Name
Dr. Kenneth R Kendall, ODNPI 1700889532
Title
Ceo
Phone
(805) 925-2637

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 3

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193200000X MULTI-SPECIALTY GROUP 152W00000X OPT5812TPG CA Primary
Ophthalmology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207W00000X G71086 CA
Ophthalmology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207W00000X

Addresses

Primary practice location

2040 Viborg Rd
#240
Solvang, CA 93463

Mailing address

910 E Stowell Rd
Santa Maria, CA 93454-7001
Phone (805) 925-2637

Other names 1

  • Shepard Eye Center Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20050128000937 CA Part B Supplier - Clinic/Group Practice 5597715391 Receives reassigned benefits from 20 practitioners
5 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Lompoc, CA; Solvang, CA; Santa Maria, CA; San Luis Obispo, CA; Orcutt, CA; Morro Bay, CA
O20200319001416 CA DME Supplier - Physician - Optometrist 5597715391 Practice locations: Solvang, CA

Other NPIs with the same Medicare PAC ID 2

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

Other NPIs on the same Medicare enrollment 5

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

National Provider Directory

National Provider Directory
Tax ID family
Elite Eyecare Medical G10 organizations share this tax ID, including this one

Other organizations with this tax ID 9

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

Locations

700 N H St
Lompoc, CA 93436
Phone (805) 736-2020

1414 E Main St
Santa Maria, CA 93454
Phone (805) 925-2637

1245 Broad St
Sn Luis Obisp, CA 93401
Phone (805) 542-0700

Practitioners & affiliated clinicians

Practitioners 19

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.

View all 19

NPI Registry JSON

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

{
    "created_epoch": "1390176000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1538352000000",
    "number": "1356763759",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "910 E STOWELL RD",
            "city": "SANTA MARIA",
            "state": "CA",
            "postal_code": "934547001",
            "telephone_number": "805-925-2637",
            "fax_number": "805-347-0033"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2040 VIBORG RD",
            "address_2": "#240",
            "city": "SOLVANG",
            "state": "CA",
            "postal_code": "93463",
            "telephone_number": "805-688-0707",
            "fax_number": "805-693-9839"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELITE EYECARE MEDICAL GROUP A MEDICAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-01-20",
        "last_updated": "2018-10-01",
        "status": "A",
        "authorized_official_last_name": "KENDALL",
        "authorized_official_first_name": "KENNETH",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "805-925-2637",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": "CA",
            "license": "OPT5812TPG",
            "primary": true
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Ophthalmology",
            "state": "CA",
            "license": "G71086",
            "primary": false
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Ophthalmology",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Shepard Eye Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Shepard Eye Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Solvang, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 2018; 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.