Individual provider Active NPI

Thomas A Aller, O.D.

  • Optometrist
  • San Bruno, CA
National Provider Identifier
1366431330
Registry record updated May 25, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
7684T Issued in CA
Practice address
648 Jenevein Ave
San Bruno, CA 94066-4230
Phone
(650) 871-1816
Fax
(650) 871-0164
NPI assigned
Oct 20, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 25, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Corneal and Contact Management Optometrist 152WC0802X 7684T CA
Optometrist 152W00000X 7684T CA Primary

Addresses

Primary practice location

648 Jenevein Ave
San Bruno, CA 94066-4230

Mailing address

648 Jenevein Ave
San Bruno, CA 94066-4230
Phone (650) 871-1816

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20060209000188 CA Practitioner - Optometry 6002821287 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
7684TCAMDCorneal and Contact Management Optometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Fourth Optometric Care of California Optometrist CurrentSince May 14, 2023 Accepting new patients
Lillie Mosaddegh MD Inc Current Accepting new patients
Fourth Optometric Care of California Optometrist Current Accepting new patients
Fourth Optometric Care of California Optometrist CurrentSince May 14, 2023 Accepting new patients

Locations

3333 Quality Dr
Rncho Cordova, CA 95670
Phone (704) 712-0564

648 Jenevein Ave
San Bruno, CA 94066
Phone (650) 583-9888

380 West Portal Ave
Ste B
San Francisco, CA 94127
Phone (415) 392-4437

Interoperability endpoints

  • Direct secure messaging: taller@sfeyedoctors.intellechartdirect.net

Organizations & group practices 4

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": "1129766400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1748131200000",
    "number": "1366431330",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "648 JENEVEIN AVE",
            "city": "SAN BRUNO",
            "state": "CA",
            "postal_code": "940664230",
            "telephone_number": "650-871-1816",
            "fax_number": "650-871-0164"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "648 JENEVEIN AVE",
            "city": "SAN BRUNO",
            "state": "CA",
            "postal_code": "940664230",
            "telephone_number": "650-871-1816",
            "fax_number": "650-871-0164"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ALLER",
        "first_name": "THOMAS",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-20",
        "last_updated": "2025-05-25",
        "certification_date": "2025-05-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152WC0802X",
            "taxonomy_group": "",
            "desc": "Optometrist, Corneal and Contact Management",
            "state": "CA",
            "license": "7684T",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "7684T",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Bruno, CA

Sources for this page

Verify at the official NPI Registry.