Organization Active NPI

Orinda Optometry Group, Inc

  • Optometrist
  • Orinda, CA
National Provider Identifier
1487843652
Registry record updated Aug 3, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
12019T Issued in CA
Legal business name
ORINDA OPTOMETRY GROUP, INC
Practice address
20 Orinda Way
Orinda, CA 94563-2519
Phone
(925) 253-1320
Fax
(925) 253-1939
NPI assigned
Oct 23, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 3, 2011

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

Authorized official

Name
Mrs. Kristine M Eng, O.D.NPI 1811997828
Title
Owner
Phone
(925) 253-1320

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X 12019T CA Primary

Addresses

Primary practice location

20 Orinda Way
Orinda, CA 94563-2519

Mailing address

20 Orinda Way
Orinda, CA 94563-2519
Phone (925) 253-1320

Other identifiers 4

IdentifierTypeStateIssuer
1811997828OtherCAINDIVIDUAL NPI
BA710ZOtherCAPTAN
1487843652OtherCAGROUP NPI
1487843652MedicaidCA

Other names 1

  • Orinda Optometry Group Former legal business name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050525000790 CA Part B Supplier - Clinic/Group Practice 5799726568 Receives reassigned benefits from 5 practitioners
Practice locations: Orinda, CA

National Provider Directory

National Provider Directory

Locations

3980 San Pablo Dam Rd
Ste 101
El Sobrante, CA 94803
Phone (510) 222-2911

20 Orinda Way
Orinda, CA 94563
Phone (925) 253-1320

Practitioners & affiliated clinicians

Practitioners 8

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": "1193097600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1312329600000",
    "number": "1487843652",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20 ORINDA WAY",
            "city": "ORINDA",
            "state": "CA",
            "postal_code": "945632519",
            "telephone_number": "925-253-1320",
            "fax_number": "925-253-1939"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20 ORINDA WAY",
            "city": "ORINDA",
            "state": "CA",
            "postal_code": "945632519",
            "telephone_number": "925-253-1320",
            "fax_number": "925-253-1939"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ORINDA OPTOMETRY GROUP, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-23",
        "last_updated": "2011-08-03",
        "status": "A",
        "authorized_official_last_name": "ENG",
        "authorized_official_first_name": "KRISTINE",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "925-253-1320",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "CA",
            "license": "12019T",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INDIVIDUAL NPI",
            "identifier": "1811997828",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PTAN",
            "identifier": "BA710Z",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP NPI",
            "identifier": "1487843652",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1487843652",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Orinda Optometry Group",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Orinda, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 3, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.