Prime Optical

Primary specialty

Eyewear SupplierTaxonomy code 332H00000X

License

SL40434 Issued in CA

Legal business name

PRIME OPTICAL

Practice address

407 E Gilbert St
Suite # 10
San Bernardino, CA 92404-5325

Phone

(909) 888-8700

Fax

(909) 888-8710

NPI assigned

Oct 8, 2015

Organization subpart

No

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

Authorized official

Name

Mr. Mariano Salcedo, RDO

Title

Owner/Optician

Phone

(909) 888-8700

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1444262400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1444262400000",
    "number": "1609247279",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "407 E GILBERT ST",
            "address_2": "SUITE # 10",
            "city": "SAN BERNARDINO",
            "state": "CA",
            "postal_code": "924045325",
            "telephone_number": "909-888-8700",
            "fax_number": "909-888-8710"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "407 E GILBERT ST",
            "address_2": "SUITE # 10",
            "city": "SAN BERNARDINO",
            "state": "CA",
            "postal_code": "924045325",
            "telephone_number": "909-888-8700",
            "fax_number": "909-888-8710"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRIME OPTICAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-10-08",
        "last_updated": "2015-10-08",
        "status": "A",
        "authorized_official_last_name": "SALCEDO",
        "authorized_official_first_name": "MARIANO",
        "authorized_official_title_or_position": "OWNER/OPTICIAN",
        "authorized_official_telephone_number": "909-888-8700",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "RDO"
    },
    "taxonomies": [
        {
            "code": "332H00000X",
            "taxonomy_group": "",
            "desc": "Eyewear Supplier",
            "state": "CA",
            "license": "SL40434",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "EIN",
            "identifier": "8005541312",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Eyewear Supplier in San Bernardino, CA
• Providers in San Bernardino, CA by specialty
• Eyewear Supplier in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 8, 2015; 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.