NPIMap

Organization Active NPI

Peter V. Hetzner, O.D.

  • Optometrist
  • Lodi, CA
National Provider Identifier
1487730172
Registry record updated Feb 15, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
5692TPA Issued in CA
Legal business name
PETER V. HETZNER, O.D.
Practice address
421 S Ham LN
Suite B
Lodi, CA 95242-3523
Phone
(209) 368-5352
Fax
(209) 368-5355
NPI assigned
Oct 27, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 15, 2013

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

Authorized official

Name
Dr. Peter Hetzner, O.D.
Title
Owner
Phone
(209) 368-5352

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X 5692TPA CA Primary

Addresses

Primary practice location

421 S Ham LN
Suite B
Lodi, CA 95242-3523

Mailing address

421 S Ham LN
Suite B
Lodi, CA 95242-3523
Phone (209) 368-5352

Other identifiers 2

IdentifierTypeStateIssuer
0622870001OtherCACIGNA MEDICARE
SD0056920MedicaidCA

Other names 1

  • Lodi Optometry Group Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Zeiter Eye Medical Group in15 organizations share this tax ID, including this one

Other organizations with this tax ID 14

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

View all 14

Practitioners & affiliated clinicians

Practitioners 2

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

NPI Registry JSON

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

{
    "created_epoch": "1161907200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1360886400000",
    "number": "1487730172",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "421 S HAM LN",
            "address_2": "SUITE B",
            "city": "LODI",
            "state": "CA",
            "postal_code": "952423523",
            "telephone_number": "209-368-5352",
            "fax_number": "209-368-5355"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "421 S HAM LN",
            "address_2": "SUITE B",
            "city": "LODI",
            "state": "CA",
            "postal_code": "952423523",
            "telephone_number": "209-368-5352",
            "fax_number": "209-368-5355"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PETER V. HETZNER, O.D.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-27",
        "last_updated": "2013-02-15",
        "status": "A",
        "authorized_official_last_name": "HETZNER",
        "authorized_official_first_name": "PETER",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "209-368-5352",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "CA",
            "license": "5692TPA",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA MEDICARE",
            "identifier": "0622870001",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "SD0056920",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lodi Optometry Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lodi, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 15, 2013; 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.