Individual provider Active NPI

Steven J Fronk, O.D.

  • Optometrist
  • Jackson, CA
National Provider Identifier
1417927161
Registry record updated Jan 25, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
8230TLG Issued in CA
Practice address
817 Court St
Suite 10
Jackson, CA 95642-2156
Phone
(209) 223-2020
Fax
(209) 223-2046
NPI assigned
Jan 25, 2006
Last updated
Jan 25, 2008By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 25, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 8230TLG CA Primary

Addresses

Primary practice location

817 Court St
Suite 10
Jackson, CA 95642-2156

Mailing address

817 Court St
Suite 10
Jackson, CA 95642-2156
Phone (209) 223-2020

Other identifiers 1

IdentifierTypeStateIssuer
SD0082300MedicaidCA

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
I20081230000094 CA Practitioner - Optometry 8224037866 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
8230TLGCAMDOptometrist

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1138147200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1201219200000",
    "number": "1417927161",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "817 COURT ST",
            "address_2": "SUITE 10",
            "city": "JACKSON",
            "state": "CA",
            "postal_code": "956422156",
            "telephone_number": "209-223-2020",
            "fax_number": "209-223-2046"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "817 COURT ST",
            "address_2": "SUITE 10",
            "city": "JACKSON",
            "state": "CA",
            "postal_code": "956422156",
            "telephone_number": "209-223-2020",
            "fax_number": "209-223-2046"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FRONK",
        "first_name": "STEVEN",
        "middle_name": "J",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-25",
        "last_updated": "2008-01-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "8230TLG",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "SD0082300",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Jackson, CA

Sources for this page

Verify at the official NPI Registry.