Individual provider Active NPI

Amanda E. Beaudry, O.D., M.S.

  • Optometrist
  • San Diego, CA
National Provider Identifier
1477903516
Registry record updated Feb 2, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
OPT33385 Issued in CA
Practice address
7910 Frost St
San Diego, CA 92123-2771
Phone
(858) 309-7702
NPI assigned
Jun 20, 2016
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 2, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X OPT33385 CA Primary

Addresses

Primary practice location

7910 Frost St
San Diego, CA 92123-2771

Mailing address

3020 Childrens Way # Mc5003
San Diego, CA 92123-4223
Phone (858) 309-6300

Other identifiers 1

IdentifierTypeStateIssuer
OPT33385OtherCAMEDICAL LICENSE

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20171129001156 CA Practitioner - Optometry 8729345798 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Science

State licenses

LicenseStateTypeSpecialty
OPT33385CAMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Sansum Clinic CurrentSince Nov 18, 2019 Accepting new patients
Sansum Clinic CurrentSince Nov 18, 2019 Accepting new patients
Sansum Clinic Current Accepting new patients
Rady Children'S Hospital San Diego CurrentSince May 30, 2024 Accepting new patients
Rady Children'S Hospital San Diego CurrentSince May 30, 2024 Accepting new patients
Marilyn Kaufhold, M.D., a Medical Corporation PastSince Feb 4, 2024 Accepting new patients

Locations

25170 Hancock Ave
Murrieta, CA 92562
Phone (858) 757-3277

7910 Frost St
San Diego, CA 92123
Phone (858) 309-7702

3020 Childrens Way
San Diego, CA 92123
Phone (858) 966-5841

3020 Childrens Way
#5003
San Diego, CA 92123
Phone (858) 309-6300

317 W Pueblo St
Santa Barbara, CA 93105
Phone (805) 681-7500

215 Pesetas Ln
Santa Barbara, CA 93110
Phone (805) 681-1765

Organizations & group practices 6

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1466380800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1706832000000",
    "number": "1477903516",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3020 CHILDRENS WAY # MC5003",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921234223",
            "telephone_number": "858-309-6300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7910 FROST ST",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921232771",
            "telephone_number": "858-309-7702"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BEAUDRY",
        "first_name": "AMANDA",
        "middle_name": "E.",
        "name_prefix": "Dr.",
        "credential": "O.D., M.S.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-06-20",
        "last_updated": "2024-02-02",
        "certification_date": "2024-02-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "OPT33385",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL LICENSE",
            "identifier": "OPT33385",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in San Diego, CA

Sources for this page

Verify at the official NPI Registry.