Active NPI
Jan William Nyssen, O.D.
- Optometrist
- Campbell, CA
National Provider Identifier
1376505529
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 8553T
- Practice address
- 1620 W Campbell Ave
Campbell, CA 95008-1535 - Phone
- (408) 376-0460
- Fax
- (408) 376-0461
- NPI assigned
- Apr 4, 2006
- Last updated
- Jul 8, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 8553T | CA | Primary |
Addresses
Primary practice location
1620 W Campbell Ave
Campbell, CA 95008-1535
Mailing address
1620 W Campbell Ave
Campbell, CA 95008-1535
Phone (408) 376-0460
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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20140815000276 | CA | Practitioner - Optometry | 2062660517 | Practice locations: Campbell, CA |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 8553T | CA | MD | Optometrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1144108800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1376505529",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1620 W CAMPBELL AVE",
"city": "CAMPBELL",
"state": "CA",
"postal_code": "950081535",
"telephone_number": "408-376-0460",
"fax_number": "408-376-0461"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1620 W CAMPBELL AVE",
"city": "CAMPBELL",
"state": "CA",
"postal_code": "950081535",
"telephone_number": "408-376-0460",
"fax_number": "408-376-0461"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NYSSEN",
"first_name": "JAN",
"middle_name": "WILLIAM",
"name_prefix": "Dr.",
"credential": "O.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-04-04",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "CA",
"license": "8553T",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Campbell, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.