Stanislaus Vision Associates Optometric Group Inc

Primary specialty

OptometristTaxonomy code 152W00000X

License

OR15 Issued in CA

Legal business name

STANISLAUS VISION ASSOCIATES OPTOMETRIC GROUP INC

Practice address

1700 McHenry Avenue
Suite 77
Modesto, CA 95350-4318

Phone

(209) 524-4626

Fax

(209) 524-1046

NPI assigned

Nov 17, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Spencer H Whatcott, ODNPI 1255405650

Title

President

Phone

(209) 524-4626

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in CA2 enrollments

Enrollment records 2

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

Locations

Practitioners 3

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

• Spencer H Whatcott, OD

  • Optometrist
  • Modesto, CA
  • NPI 1255405650
  Medicare reassignment Care Compare group NPD Authorized official
• Eric E Miedema, OD

  • Optometrist
  • Modesto, CA
  • NPI 1336213735
  Medicare reassignment Care Compare group NPD
• James F Bragno, O.D.

  • Optometrist
  • Modesto, CA
  • NPI 1588666382
  NPD (past)

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

{
    "created_epoch": "1163721600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1328486400000",
    "number": "1457425852",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1700 MCHENRY AVENUE",
            "address_2": "SUITE 77",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953504318",
            "telephone_number": "209-524-4626",
            "fax_number": "209-524-1046"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1700 MCHENRY AVENUE",
            "address_2": "SUITE 77",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953504318",
            "telephone_number": "209-524-4626",
            "fax_number": "209-524-1046"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STANISLAUS VISION ASSOCIATES OPTOMETRIC GROUP INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-17",
        "last_updated": "2012-02-06",
        "status": "A",
        "authorized_official_last_name": "WHATCOTT",
        "authorized_official_first_name": "SPENCER",
        "authorized_official_middle_name": "H",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "209-524-4626",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": "CA",
            "license": "OR15",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLARITY VISION",
            "identifier": "ST1529366",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL EYE SERVICES",
            "identifier": "02421",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GSD000120",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Stanislaus Surgical Hospital LLC
• Stanislaus Union School District
• Christle Chenille Stanton, FNP-BC
• James Lewis Stanton, M.D.
• Jonathon Robert Staples, MD
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• Brooke Elizabeth Stark

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 6, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.

Verify at the official NPI Registry.