NPIMap

Organization Active NPI

North Bay Eye Associates, a Medical Corporation

  • Ophthalmology Physician
  • Santa Rosa, CA
National Provider Identifier
1376729988
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
Legal business name
NORTH BAY EYE ASSOCIATES, A MEDICAL CORPORATION
Practice address
380 Tesconi CT
Santa Rosa, CA 95401-4653
Phone
(707) 544-3375
Fax
(707) 544-0808
NPI assigned
Jan 14, 2008
Organization subpart
Yes
Parent organization
NORTH BAY EYE ASSOCIATES, A MEDICAL CORPORATIONAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Authorized official

Name
Kimberlee K Breslin
Title
Accounts Recievable Manager
Phone
(707) 588-7946

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Ophthalmology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207W00000X Primary
Durable Medical Equipment & Medical Supplies 332B00000X CA

Addresses

Primary practice location

380 Tesconi CT
Santa Rosa, CA 95401-4653

Mailing address

PO Box 11688
Santa Rosa, CA 95406-1688
Phone (707) 588-7946

Other names 1

  • North Bay Eye Associates, Inc Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20101221001019 CA DME Supplier - Physician - OptometristDME Supplier - Optician 9436147980 Practice locations: Santa Rosa, CA

Other NPIs with the same Medicare PAC ID 4

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

National Provider Directory

National Provider Directory
Tax ID family
North Bay Eye Associates6 organizations share this tax ID, including this one
Part of
North Bay Eye Associates

Other organizations with this tax ID 5

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

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

NPI Registry JSON

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

{
    "created_epoch": "1200268800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1376729988",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 11688",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954061688",
            "telephone_number": "707-588-7946",
            "fax_number": "707-588-7940"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "380 TESCONI CT",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954014653",
            "telephone_number": "707-544-3375",
            "fax_number": "707-544-0808"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTH BAY EYE ASSOCIATES, A MEDICAL CORPORATION",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "NORTH BAY EYE ASSOCIATES, A MEDICAL CORPORATION",
        "enumeration_date": "2008-01-14",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "BRESLIN",
        "authorized_official_first_name": "KIMBERLEE",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "ACCOUNTS RECIEVABLE MANAGER",
        "authorized_official_telephone_number": "707-588-7946"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Ophthalmology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "CA",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "North Bay Eye Associates, Inc",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Santa Rosa, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.