NPIMap

Organization Active NPI

Elite Eyecare Medical Group a Medical Corporation

Doing business as Kendall Optometry

  • Optometrist
  • Lompoc, CA
National Provider Identifier
1437117231
Registry record updated Oct 10, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
Legal business name
ELITE EYECARE MEDICAL GROUP A MEDICAL CORPORATION
Doing business as
Kendall Optometry
Practice address
425 W Central Ave Ste 102
Lompoc, CA 93436
Phone
(805) 736-2020
Fax
(805) 737-1733
NPI assigned
May 2, 2006
Last updated
Oct 10, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 10, 2018

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

Authorized official

Name
Stephen Bylsma, MDNPI 1265435325
Title
President
Phone
(805) 925-2637

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X NU Primary
Ophthalmology Physician 207W00000X NU

Addresses

Primary practice location

425 W Central Ave Ste 102
Lompoc, CA 93436

Mailing address

910 E Stowell Rd
Santa Maria, CA 93454-7001
Phone (805) 925-2637

Other identifiers 3

IdentifierTypeStateIssuer
GSD004611MedicaidCA
GR0086920MedicaidCA
ZZZ61060ZOtherCABLUE SHIELD OF CA

Other names 1

  • Kendall Optometry Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050128000937 CA Part B Supplier - Clinic/Group Practice 5597715391 Receives reassigned benefits from 20 practitioners
5 other NPIs on this enrollment
Practice locations: Lompoc, CA; Solvang, CA; Santa Maria, CA; San Luis Obispo, CA; Orcutt, CA; Morro Bay, CA

Other NPIs with the same Medicare PAC ID 2

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

Other NPIs on the same Medicare enrollment 5

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Elite Eyecare Medical Group a Medical Corporation10 organizations share this tax ID, including this one

Other organizations with this tax ID 9

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

Locations

425 W Central Ave
Ste 102
Lompoc, CA 93436
Phone (805) 736-2020

Practitioners & affiliated clinicians

Practitioners 21

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 21

NPI Registry JSON

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

{
    "created_epoch": "1146528000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1539129600000",
    "number": "1437117231",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "910 E STOWELL RD",
            "city": "SANTA MARIA",
            "state": "CA",
            "postal_code": "934547001",
            "telephone_number": "805-925-2637",
            "fax_number": "805-347-0033"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "425 W CENTRAL AVE STE 102",
            "city": "LOMPOC",
            "state": "CA",
            "postal_code": "93436",
            "telephone_number": "805-736-2020",
            "fax_number": "805-737-1733"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELITE EYECARE MEDICAL GROUP A MEDICAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-02",
        "last_updated": "2018-10-10",
        "status": "A",
        "authorized_official_last_name": "BYLSMA",
        "authorized_official_first_name": "STEPHEN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "805-925-2637",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GSD004611",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0086920",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD OF CA",
            "identifier": "ZZZ61060Z",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Kendall Optometry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lompoc, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 10, 2018; 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.