Active NPI
Douglas J. Hollabaugh, O.D.
- Optometrist
- El Dorado Hills, CA
National Provider Identifier
1407908692
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 9879TPA
- Practice address
- 899 Embarcadero Dr
Ste 3
El Dorado Hills, CA 95762-4094 - Phone
- (916) 939-6631
- NPI assigned
- Jan 17, 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 | 9879TPA | CA | Primary |
Addresses
Primary practice location
899 Embarcadero Dr
Ste 3
El Dorado Hills, CA 95762-4094
Mailing address
899 Embarcadero Dr
Ste 3
El Dorado Hills, CA 95762-4094
Phone (916) 939-6631
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 |
|---|---|---|---|---|
| I20081003000621 | CA | Practitioner - Optometry | 0749358760 | Practice locations: El Dorado Hills, CA |
Care Compare profile
Medicare Care Compare- Specialty
- Optometry
- Education
- University of California - School of Optometry, 1992
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
899 Embarcadero Dr
Suite 3
El Dorado Hills, CA 95762-4094
Phone (916) 939-6631
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Cataract surgery | 1-10 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 9879TPA | CA | MD | Optometrist |
| 9879 | CA | MD | Pediatric Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1168992000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1228089600000",
"number": "1407908692",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "899 EMBARCADERO DR",
"address_2": "STE 3",
"city": "EL DORADO HILLS",
"state": "CA",
"postal_code": "957624094",
"telephone_number": "916-939-6631"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "899 EMBARCADERO DR",
"address_2": "STE 3",
"city": "EL DORADO HILLS",
"state": "CA",
"postal_code": "957624094",
"telephone_number": "916-939-6631"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HOLLABAUGH",
"first_name": "DOUGLAS",
"middle_name": "J.",
"credential": "O.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-01-17",
"last_updated": "2008-12-01",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "CA",
"license": "9879TPA",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in El Dorado Hills, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 1, 2008; 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.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.