Individual provider Active NPI

Theresa Floresca, O.D.

  • Optometrist
  • San Diego, CA
National Provider Identifier
1629356563
Registry record updated Nov 15, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
14206 Issued in CA
Practice address
2260 Callagan Hwy BLDG 3187
San Diego, CA 92136-2222
Phone
(619) 550-2679
Fax
(619) 664-4290
NPI assigned
Jul 26, 2011
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 15, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 14206 CA Primary

Addresses

Primary practice location

2260 Callagan Hwy BLDG 3187
San Diego, CA 92136-2222

Mailing address

12494 Brickellia St
San Diego, CA 92129-4156
Phone (858) 837-4650

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA, HI2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20180523000918 CA Practitioner - Optometry 8729343777 Reassigns benefits to 1 organization
I20210809000563 HI Practitioner - Optometry 8729343777 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Family Optometric Associates P.C. Optometrist CurrentSince Jul 12, 2021 Accepting new patients
Family Optometric Associates of California, Inc. Optometrist CurrentSince May 9, 2018 Accepting new patients
Eye to Eye of Frederick Inc Optometrist Past Accepting new patients

Locations

2260 Callagan Hwy
San Diego, CA 92136
Phone (619) 544-2284

2260 Callagan Hwy
Bldg 3187
San Diego, CA 92136
Phone (619) 550-2679

4725 Bougainville Dr
Honolulu, HI 96818
Phone (808) 312-3878

2060 Yellow Springs Rd
Ste 104
Frederick, MD 21702
Phone (301) 662-5474

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.

NPI Registry JSON

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

{
    "created_epoch": "1311638400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1636934400000",
    "number": "1629356563",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12494 BRICKELLIA ST",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921294156",
            "telephone_number": "858-837-4650"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2260 CALLAGAN HWY BLDG 3187",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921362222",
            "telephone_number": "619-550-2679",
            "fax_number": "619-664-4290"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FLORESCA",
        "first_name": "THERESA",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-07-26",
        "last_updated": "2021-11-15",
        "certification_date": "2021-11-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "14206",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Diego, CA

Sources for this page

Verify at the official NPI Registry.