Traci Lynn Dolezel, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

OPT12894T Issued in CA

Practice address

2801 Waterman Blvd Ste 160
Fairfield, CA 94534-2987

Phone

(707) 427-5550

NPI assigned

Jul 9, 2006

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

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

Practice roles

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.

• Florentino Nantes & Ernesto Juarez

  dba Site for Sore Eyes 503

  • Optician
  • Berkeley, CA
  • NPI 1114561834
  NPD (past)
• Soreeyes Enterprises, Inc.

  dba Site For Sore Eyes

  • Optician
  • Berkeley, CA
  • NPI 1316798606
  NPD (past)

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

{
    "created_epoch": "1152403200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1467485672",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 43282",
            "city": "OAKLAND",
            "state": "CA",
            "postal_code": "946240282",
            "telephone_number": "586-295-1396"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2801 WATERMAN BLVD STE 160",
            "city": "FAIRFIELD",
            "state": "CA",
            "postal_code": "945342987",
            "telephone_number": "707-427-5550"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DOLEZEL",
        "first_name": "TRACI",
        "middle_name": "LYNN",
        "name_prefix": "Miss",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-07-09",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "OPT12894T",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Doc's Medical Mart (Bischoff's Medical Supplies)
• Sasha Capri R Doctor
• Pramoda Madubhashani Dodangoda Arachchige, HIS
• Doing Better Counseling, Marriage & Family Therapy, Prof.Corp
• Sarah Dolar, H.I.S.
• Darrah Dominguez
• Joseph J Dominguez, M.D.
• Rachelle Dominguez
• Donald R Doyle MD Inc a Professional Corp
• Diandria Aliysha Donaldson, LCSW

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.