Taylor D Tedder, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

13350 Issued in CA

Practice address

766 W Los Angeles Ave
D3
Moorpark, CA 93021-9302

Phone

(805) 523-3440

NPI assigned

Sep 13, 2007

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in CA, WA2 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

Specialty

Optometry

Education

Illinois College of Optometry at Chicago, 2007

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Tedder Optometric Clinic Management, P.C.

  • Optometrist
  • Fontana, CA
  • NPI 1851091805
  Medicare reassignment NPD Authorized official
• Tedder Optometry Group, PC

  • Optometrist
  • San Dimas, CA
  • NPI 1184484222
  Medicare reassignment NPD
• Blue Wave Eye Doctors Professional Limited Liability Company

  • Optometrist
  • Everett, WA
  • NPI 1053060475
  Medicare reassignment NPD
• Blue Wave Eye Doctors Professional Limited Liability Company

  dba Visionworks Doctors Optometry

  • Eyewear Supplier
  • Olympia, WA
  • NPI 1902608755
  NPD
• Hansra Optometric Corporation

  dba Visionworks

  • Eyewear Supplier
  • Sacramento, CA
  • NPI 1366258436
  NPD (past)

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

{
    "created_epoch": "1189641600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1661817600000",
    "number": "1639364532",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "766 W LOS ANGELES AVE",
            "address_2": "D3",
            "city": "MOORPARK",
            "state": "CA",
            "postal_code": "93021",
            "telephone_number": "805-523-3440"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "766 W LOS ANGELES AVE",
            "address_2": "D3",
            "city": "MOORPARK",
            "state": "CA",
            "postal_code": "930219302",
            "telephone_number": "805-523-3440"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "518 N Moorpark Rd",
            "address_purpose": "LOCATION",
            "city": "Thousand Oaks",
            "state": "CA",
            "postal_code": "913603703",
            "country_code": "US",
            "telephone_number": "805-373-0599",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TEDDER",
        "first_name": "TAYLOR",
        "middle_name": "D",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-09-13",
        "last_updated": "2022-08-30",
        "certification_date": "2022-08-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "13350T",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "13350",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nicole Storbakken
• Bobby Suministrado, PTA
• Carmen Arando Summers, MSN, APRN, FNP-C
• Allen Taniguchi, PHARM D
• Kimberly A Tedder, O.D.
• The Meadowglade, LLC
• The Meadowglade, LLC
• Crystal Rene Thomas, PT
• Thorne Dent Corporation (Moorpark Smiles Dental Group)
• John Michael Thorne, DDS

• Optometrist in Moorpark, CA
• Providers in Moorpark, CA by specialty
• Optometrist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 30, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.