Active NPI
Lincoln Andrus Service Jr., O.D.
- Optometrist
- Modesto, CA
National Provider Identifier
1619028842
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 7573
- Practice address
- 3500 Sisk Rd
Best Plaza Ste E
Modesto, CA 95356-0550 - Phone
- (209) 545-4457
- Fax
- (209) 545-2416
- NPI assigned
- Jan 15, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 7573 | CA | Primary |
Addresses
Primary practice location
3500 Sisk Rd
Best Plaza Ste E
Modesto, CA 95356-0550
Mailing address
752 Madrid St
San Francisco, CA 94112-3547
Phone (415) 452-8225
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
| License | State | Type | Specialty |
|---|---|---|---|
| 7573 | CA | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Luxottica of America Inc. | Past | Accepting new patients | |
| Luxottica of America Inc. | Past | Accepting new patients | |
| Luxottica of America Inc | Past | Accepting new patients |
Organizations & group practices 3
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
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- Eyewear Supplier
- Riverside, CA
- NPI 1366598120
-
- Eyewear Supplier
- Modesto, CA
- NPI 1841345394
-
- Eyewear Supplier
- Kansas City, MO
- NPI 1497412522
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1168819200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1619028842",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "752 MADRID ST",
"city": "SAN FRANCISCO",
"state": "CA",
"postal_code": "941123547",
"telephone_number": "415-452-8225"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3500 SISK RD",
"address_2": "BEST PLAZA STE E",
"city": "MODESTO",
"state": "CA",
"postal_code": "953560550",
"telephone_number": "209-545-4457",
"fax_number": "209-545-2416"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SERVICE",
"first_name": "LINCOLN",
"middle_name": "ANDRUS",
"name_suffix": "Jr.",
"credential": "O.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-01-15",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "CA",
"license": "7573",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Modesto, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 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.