Raymond F Pedersen, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

8564T Issued in CA

Practice address

38069 Martha Ave
Suite 200
Fremont, CA 94536-3811

Phone

(510) 791-5272

Fax

(510) 791-0660

NPI assigned

Aug 22, 2005

Last updated

Feb 10, 2016By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Raymond F Pedersen OD Professional Professional name

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

Medicare enrollment (NPD)

Enrolled

State licenses

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.

• Raymond F Pedersen O.D. Professional

  • Optometrist
  • Fremont, CA
  • NPI 1467589077
  Authorized official Same address or phone

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

{
    "created_epoch": "1124668800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1455062400000",
    "number": "1457343717",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "38069 MARTHA AVE",
            "address_2": "SUITE 200",
            "city": "FREMONT",
            "state": "CA",
            "postal_code": "945363811",
            "telephone_number": "510-791-5272",
            "fax_number": "510-791-0660"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "38069 MARTHA AVE",
            "address_2": "SUITE 200",
            "city": "FREMONT",
            "state": "CA",
            "postal_code": "945363811",
            "telephone_number": "510-791-5272",
            "fax_number": "510-791-0660"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PEDERSEN",
        "first_name": "RAYMOND",
        "middle_name": "F",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-22",
        "last_updated": "2016-02-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "8564T",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "SD0085640",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "RAYMOND",
            "last_name": "PEDERSEN OD PROFESSIONAL",
            "middle_name": "F",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

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• Optometrist in Fremont, CA
• Providers in Fremont, CA by specialty
• Optometrist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 10, 2016; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.