Active NPI
Clifford Wayne Upshaw
- Optometrist
- Tracy, CA
National Provider Identifier
1639330350
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 12241T
- Practice address
- 3250 W Grant Line Rd
Tracy, CA 95304-8427 - Phone
- (209) 836-3937
- Fax
- (209) 836-3466
- NPI assigned
- Jun 25, 2008
- Last updated
- Jun 25, 2008
- Sex
- Male
- Sole proprietor
- Yes
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 | 12241T | CA | Primary |
Addresses
Primary practice location
3250 W Grant Line Rd
Tracy, CA 95304-8427
Mailing address
3250 W Grant Line Rd
Tracy, CA 95304-8427
Phone (209) 836-3937
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 12241T | CA | MD | Optometrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1214352000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1214352000000",
"number": "1639330350",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3250 W GRANT LINE RD",
"city": "TRACY",
"state": "CA",
"postal_code": "953048427",
"telephone_number": "209-836-3937",
"fax_number": "209-836-3466"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3250 W GRANT LINE RD",
"city": "TRACY",
"state": "CA",
"postal_code": "953048427",
"telephone_number": "209-836-3937",
"fax_number": "209-836-3466"
}
],
"practiceLocations": [],
"basic": {
"last_name": "UPSHAW",
"first_name": "CLIFFORD",
"middle_name": "WAYNE",
"name_prefix": "Dr.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2008-06-25",
"last_updated": "2008-06-25",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "CA",
"license": "12241T",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Tracy, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.