Organization Active NPI

Fremont Optometric Group

  • Optometrist
  • Fremont, CA
National Provider Identifier
1619991080
Registry record updated Jul 6, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
4655T Issued in CA
Legal business name
FREMONT OPTOMETRIC GROUP
Practice address
39355 California St
Suite 103
Fremont, CA 94538-1447
Phone
(510) 744-2010
Fax
(510) 744-2015
NPI assigned
Jul 27, 2006
Last updated
Jul 6, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 6, 2016

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

Authorized official

Name
Dr. Debora D Chew, O.D
Title
Optometrist/Owner
Phone
(510) 744-2010

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X 4655T CA Primary

Addresses

Primary practice location

39355 California St
Suite 103
Fremont, CA 94538-1447

Mailing address

39355 California St
Suite 103
Fremont, CA 94538-1447
Phone (510) 744-2010

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050502000533 CA Part B Supplier - Clinic/Group Practice 9638118342 Receives reassigned benefits from 6 practitioners
Practice locations: Fremont, CA

National Provider Directory

National Provider Directory

Locations

39355 California St
Ste 103
Fremont, CA 94538
Phone (510) 744-2010

Practitioners & affiliated clinicians

Practitioners 11

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": "1153958400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1467763200000",
    "number": "1619991080",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "39355 CALIFORNIA ST",
            "address_2": "SUITE 103",
            "city": "FREMONT",
            "state": "CA",
            "postal_code": "945381447",
            "telephone_number": "510-744-2010",
            "fax_number": "510-744-2015"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "39355 CALIFORNIA ST",
            "address_2": "SUITE 103",
            "city": "FREMONT",
            "state": "CA",
            "postal_code": "945381447",
            "telephone_number": "510-744-2010",
            "fax_number": "510-744-2015"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FREMONT OPTOMETRIC GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-27",
        "last_updated": "2016-07-06",
        "status": "A",
        "authorized_official_last_name": "CHEW",
        "authorized_official_first_name": "DEBORA",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "OPTOMETRIST/OWNER",
        "authorized_official_telephone_number": "510-744-2010",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "CA",
            "license": "4655T",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fremont, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 6, 2016; 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.