Bruce David Herzog, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

OPT8087 Issued in CA

Practice address

3555 Clares St Ste H
Capitola, CA 95010-2539

Phone

(831) 477-4900

Fax

(831) 477-4909

NPI assigned

Sep 23, 2006

Last updated

Feb 18, 2016By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 3

Other names 1

• Dr. David Herzog Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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

• LMT Vision Care Inc

  dba Site for Sore Eyes

  • Optician
  • Capitola, CA
  • NPI 1619520061
  NPD (past)
• Site for Sore Eyes

  • Optician
  • Capitola, CA
  • NPI 1194844837
  NPD (past)

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

{
    "created_epoch": "1158969600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1455753600000",
    "number": "1366542961",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3555 CLARES ST STE H",
            "city": "CAPITOLA",
            "state": "CA",
            "postal_code": "950102539",
            "telephone_number": "831-477-4900",
            "fax_number": "831-477-4909"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3555 CLARES ST STE H",
            "city": "CAPITOLA",
            "state": "CA",
            "postal_code": "950102539",
            "telephone_number": "831-477-4900",
            "fax_number": "831-477-4909"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HERZOG",
        "first_name": "BRUCE",
        "middle_name": "DAVID",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-09-23",
        "last_updated": "2016-02-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "OPT8087",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "410014677",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0086942",
            "state": "IA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "EYEMED",
            "identifier": "910904",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "DAVID",
            "last_name": "HERZOG",
            "prefix": "DR.",
            "credential": "O.D.",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Health in Mind P.C.
• Sharon L. Heckert, D.C.
• Jennifer Zee Henrikson, OD
• Ann Marie Hernandez
• Stephen Herrington
• Christian S Heywood, M.D.
• High Performance Medicine
• Nina-Katreen Hipkins
• Lisa Holden, LMFT131412
• Jonathan Holtz, PT

• Optometrist in Capitola, CA
• Providers in Capitola, CA by specialty
• Optometrist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 18, 2016; 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.