NPIMap

Organization Active NPI

San Clemente Optometry Corp

  • Optometrist
  • San Clemente, CA
National Provider Identifier
1427366145
Registry record updated Apr 18, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
10391T Issued in CA
Legal business name
SAN CLEMENTE OPTOMETRY CORP
Practice address
224 Avenida del Mar
Suite a
San Clemente, CA 92672-4011
Phone
(949) 492-2029
Fax
(949) 492-0049
NPI assigned
Sep 15, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 18, 2011

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

Authorized official

Name
Dr. David J Nota, O.D.
Title
President
Phone
(949) 492-2029

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X 10391T CA Primary

Addresses

Primary practice location

224 Avenida del Mar
Suite a
San Clemente, CA 92672-4011

Mailing address

224 Avenida del Mar
Suite a
San Clemente, CA 92672-4011
Phone (949) 492-2029

Other identifiers 1

IdentifierTypeStateIssuer
SD0103910MedicaidCA

National Provider Directory

National Provider Directory

Locations

224 Avenida del Mar
San Clemente, CA 92672

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1284508800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1303084800000",
    "number": "1427366145",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "224 AVENIDA DEL MAR",
            "address_2": "SUITE A",
            "city": "SAN CLEMENTE",
            "state": "CA",
            "postal_code": "926724011",
            "telephone_number": "949-492-2029",
            "fax_number": "949-492-0049"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "224 AVENIDA DEL MAR",
            "address_2": "SUITE A",
            "city": "SAN CLEMENTE",
            "state": "CA",
            "postal_code": "926724011",
            "telephone_number": "949-492-2029",
            "fax_number": "949-492-0049"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAN CLEMENTE OPTOMETRY CORP",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-09-15",
        "last_updated": "2011-04-18",
        "status": "A",
        "authorized_official_last_name": "NOTA",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "949-492-2029",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "CA",
            "license": "10391T",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "SD0103910",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in San Clemente, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 18, 2011; 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.