Central Valley Eye Medical Group Inc.

Primary specialty

Eyewear SupplierTaxonomy code 332H00000X

Legal business name

CENTRAL VALLEY EYE MEDICAL GROUP INC.

Practice address

200 Cottage Ave
Ste 102
Manteca, CA 95336-4935

Phone

(209) 239-5303

Fax

(209) 239-0090

NPI assigned

Apr 4, 2007

Last updated

Oct 8, 2014By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Stevens Y Kim, MDNPI 1437258183

Title

Treasurer

Phone

(209) 952-3700

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Other NPIs with the same Medicare PAC ID 1

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

• Central Valley Eye Medical Group Inc.

  • Ophthalmology Physician
  • Stockton, CA
  • NPI 1609975366

  8729178843

  Same PAC ID

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

Tax ID family

Central Valley Eye Medical Group3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

• Central Valley Eye Medical Group

  • Eyewear Supplier
  • Stockton, CA
  • NPI 1619099413
  NPD tax ID
• Central Valley Eye Medical Group Inc.

  • Ophthalmology Physician
  • Stockton, CA
  • NPI 1609975366
  NPD tax ID

Locations

Practitioners 1

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.

• Stevens Young-Jun Kim, MD

  • Ophthalmology Physician
  • Stockton, CA
  • NPI 1437258183
  Authorized official Same address or phone

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

{
    "created_epoch": "1175644800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1412726400000",
    "number": "1477675387",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "36 W YOKUTS AVE",
            "address_2": "STE 1",
            "city": "STOCKTON",
            "state": "CA",
            "postal_code": "952075713"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 COTTAGE AVE",
            "address_2": "STE 102",
            "city": "MANTECA",
            "state": "CA",
            "postal_code": "953364935",
            "telephone_number": "209-239-5303",
            "fax_number": "209-239-0090"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTRAL VALLEY EYE MEDICAL GROUP INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-04",
        "last_updated": "2014-10-08",
        "status": "A",
        "authorized_official_last_name": "KIM",
        "authorized_official_first_name": "STEVENS",
        "authorized_official_middle_name": "Y",
        "authorized_official_title_or_position": "TREASURER",
        "authorized_official_telephone_number": "209-952-3700",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "332H00000X",
            "taxonomy_group": "",
            "desc": "Eyewear Supplier",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0076150",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Chanai Catarich, CD,PCD
• Geraldine Cruz Ceballos, MS
• Center for Sight of Stockton a Medical Corporation (Philip Edington, MD)
• Center St LLC
• Central Valley Cardiovascular Associates Inc
• Central Valley Imaging Medical Assoc, Inc
• Central Valley Imaging Medical Associates Inc
• Central Valley Imaging Medical Associates Inc
• Central Valley Imaging Medical Associates Inc
• Central Valley Imaging Medical Associates, Inc

• Eyewear Supplier in Manteca, CA
• Providers in Manteca, CA by specialty
• Eyewear Supplier in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 8, 2014; 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.