Individual provider Active NPI

Robert Lesley Schoenberg, OD

  • Optometrist
  • Pomona, CA
National Provider Identifier
1518921436
Registry record updated Aug 13, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
CA7050T Issued in CA
Practice address
1204 N Garey Ave
Pomona, CA 91767-3806
Phone
(909) 622-1301
Fax
(909) 623-6061
NPI assigned
Apr 17, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 13, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X CA7050T CA Primary

Addresses

Primary practice location

1204 N Garey Ave
Pomona, CA 91767-3806

Mailing address

1204 N Garey Ave
Pomona, CA 91767-3806
Phone (909) 622-1301

Other identifiers 1

IdentifierTypeStateIssuer
SD0070500MedicaidCA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
CA7050TCAMDOptometrist

NPI Registry JSON

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

{
    "created_epoch": "1145232000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1186963200000",
    "number": "1518921436",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1204 N GAREY AVE",
            "city": "POMONA",
            "state": "CA",
            "postal_code": "917673806",
            "telephone_number": "909-622-1301",
            "fax_number": "909-623-6061"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1204 N GAREY AVE",
            "city": "POMONA",
            "state": "CA",
            "postal_code": "917673806",
            "telephone_number": "909-622-1301",
            "fax_number": "909-623-6061"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SCHOENBERG",
        "first_name": "ROBERT",
        "middle_name": "LESLEY",
        "name_prefix": "Mr.",
        "credential": "OD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-04-17",
        "last_updated": "2007-08-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "CA7050T",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "SD0070500",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Pomona, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 13, 2007; 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.