Mendocino Optical Co Inc

Primary specialty

Eyewear SupplierTaxonomy code 332H00000X

License

461 Issued in CA

Legal business name

MENDOCINO OPTICAL CO INC

Practice address

280 S School St
Ukiah, CA 95482-4828

Phone

(707) 462-2744

Fax

(707) 462-8789

NPI assigned

Jun 15, 2006

Organization subpart

No

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

Authorized official

Name

Mrs. Anne Marie Nix, LDO

Title

Owner Optician

Phone

(707) 462-2744

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

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

{
    "created_epoch": "1150329600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1218499200000",
    "number": "1528002201",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "280 S SCHOOL ST",
            "city": "UKIAH",
            "state": "CA",
            "postal_code": "954824828",
            "telephone_number": "707-462-2744",
            "fax_number": "707-462-8789"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "280 S SCHOOL ST",
            "city": "UKIAH",
            "state": "CA",
            "postal_code": "954824828",
            "telephone_number": "707-462-2744",
            "fax_number": "707-462-8789"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MENDOCINO OPTICAL CO INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-15",
        "last_updated": "2008-08-12",
        "status": "A",
        "authorized_official_last_name": "NIX",
        "authorized_official_first_name": "ANNE",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "OWNER OPTICIAN",
        "authorized_official_telephone_number": "707-462-2744",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "LDO"
    },
    "taxonomies": [
        {
            "code": "332H00000X",
            "taxonomy_group": "",
            "desc": "Eyewear Supplier",
            "state": "CA",
            "license": "461",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "DX003663F5",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MESC BLUE SHIELD",
            "identifier": "1247",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Mendocino County Youth Project
• Mendocino County Youth Project
• Mendocino County Youth Project
• Mendocino Lake Audiology Inc.
• Mendocino Lake Hearing Care, Inc
• Mendocino Physical Therapy
• Jorge Mendoza Reyes
• Celene Marie Mendoza, INTAKE SPECIALIST
• Jasmin Mendoza
• Olga Mendoza

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 2008; 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.