NPIMap

Organization Active NPI

Raymond F Pedersen O.D. Professional

  • Optometrist
  • Fremont, CA
National Provider Identifier
1467589077
Registry record updated Apr 19, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
8564T Issued in CA
Legal business name
RAYMOND F PEDERSEN O.D. PROFESSIONAL
Practice address
38069 Martha Ave
Ste 200
Fremont, CA 94536-3811
Phone
(510) 791-5272
Fax
(510) 791-0660
NPI assigned
Feb 28, 2007
Last updated
Apr 19, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 19, 2016

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

Authorized official

Name
Dr. Raymond F Pedersen, ODNPI 1457343717
Title
Owner
Phone
(510) 791-5272

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 8564T CA Primary

Addresses

Primary practice location

38069 Martha Ave
Ste 200
Fremont, CA 94536-3811

Mailing address

38069 Martha Ave
Ste 200
Fremont, CA 94536-3811
Phone (510) 791-5272

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 13

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 13

NPI Registry JSON

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

{
    "created_epoch": "1172620800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1461024000000",
    "number": "1467589077",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "38069 MARTHA AVE",
            "address_2": "STE 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": "STE 200",
            "city": "FREMONT",
            "state": "CA",
            "postal_code": "945363811",
            "telephone_number": "510-791-5272",
            "fax_number": "510-791-0660"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RAYMOND F PEDERSEN O.D. PROFESSIONAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-28",
        "last_updated": "2016-04-19",
        "status": "A",
        "authorized_official_last_name": "PEDERSEN",
        "authorized_official_first_name": "RAYMOND",
        "authorized_official_middle_name": "F",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "510-791-5272",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "8564T",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fremont, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 19, 2016; 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.