NPIMap

Organization Active NPI

Eye Specialties Medical Group Inc.

  • Ophthalmology Physician
  • Castro Valley, CA
National Provider Identifier
1568030260
Registry record updated Oct 8, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
Legal business name
EYE SPECIALTIES MEDICAL GROUP INC.
Doing business as
Eye Specialties Medical Group Inc.
Practice address
20046 Lake Chabot Rd
Castro Valley, CA 94546-5304
Phone
(510) 881-8823
Fax
(510) 881-2134
NPI assigned
Jun 17, 2021
Last updated
Oct 8, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 8, 2021

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

Authorized official

Name
Ms. Deborah H Tafoya
Title
Practice Administrator
Phone
(510) 881-8823

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ophthalmology Physician 207W00000X NU Primary

Addresses

Primary practice location

20046 Lake Chabot Rd
Castro Valley, CA 94546-5304

Mailing address

20046 Lake Chabot Rd
Castro Valley, CA 94546-5304
Phone (510) 881-8823

Other identifiers 1

IdentifierTypeStateIssuer
1007110001MedicaidCA

Other names 1

  • Eye Specialties Medical Group Inc. Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL Signal Direct

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20220316000612 CA Part B Supplier - Clinic/Group Practice 1557756251 Receives reassigned benefits from 4 practitioners
Practice locations: Castro Valley, CA

National Provider Directory

National Provider Directory

Locations

20046 Lake Chabot Rd
Castro Valley, CA 94546
Phone (510) 881-8823

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1623888000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1633651200000",
    "number": "1568030260",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20046 LAKE CHABOT RD",
            "city": "CASTRO VALLEY",
            "state": "CA",
            "postal_code": "945465304",
            "telephone_number": "510-881-8823",
            "fax_number": "510-881-2134"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20046 LAKE CHABOT RD",
            "city": "CASTRO VALLEY",
            "state": "CA",
            "postal_code": "945465304",
            "telephone_number": "510-881-8823",
            "fax_number": "510-881-2134"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EYE SPECIALTIES MEDICAL GROUP INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-06-17",
        "last_updated": "2021-10-08",
        "certification_date": "2021-10-08",
        "status": "A",
        "authorized_official_last_name": "TAFOYA",
        "authorized_official_first_name": "DEBORAH",
        "authorized_official_middle_name": "H",
        "authorized_official_title_or_position": "PRACTICE ADMINISTRATOR",
        "authorized_official_telephone_number": "510-881-8823",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1007110001",
            "state": "CA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "Signal",
            "affiliation": "N",
            "endpointDescription": "Communication with Doctors on through Signal App",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "SQLCliper",
            "address_1": "20046 Lake Chabot Rd",
            "city": "Castro Valley",
            "state": "CA",
            "country_code": "US",
            "postal_code": "945465304",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Eye Specialties Medical Group Inc.",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Castro Valley, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 8, 2021; 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.