NPIMap

Organization Active NPI

Mark a Fujikawa & Stephen R Chun PTR

Doing business as The Berkeley Optometric Group

  • Optometrist
  • Berkeley, CA
National Provider Identifier
1639394166
Registry record updated Apr 20, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
FNP 393 Issued in CA
Legal business name
MARK A FUJIKAWA & STEPHEN R CHUN PTR
Doing business as
The Berkeley Optometric Group
Practice address
2414 Shattuck Ave
Berkeley, CA 94704-2023
Phone
(510) 843-1228
Fax
(510) 843-2080
NPI assigned
Apr 17, 2007
Last updated
Apr 20, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 20, 2015

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

Authorized official

Name
Dr. Mark A Fujikawa, O.D.NPI 1366507352
Title
Partner
Phone
(510) 843-1228

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X FNP 393 CA Primary

Addresses

Primary practice location

2414 Shattuck Ave
Berkeley, CA 94704-2023

Mailing address

2414 Shattuck Ave
Berkeley, CA 94704-2023
Phone (510) 843-1228

Other names 1

  • The Berkeley Optometric Group Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050719001228 CA Part B Supplier - Clinic/Group Practice 8921035122 Receives reassigned benefits from 3 practitioners
Practice locations: Berkeley, CA

National Provider Directory

National Provider Directory

Locations

2414 Shattuck Ave
Berkeley, CA 94704
Phone (510) 843-1228

Practitioners & affiliated clinicians

Practitioners 6

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": "1176768000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1429488000000",
    "number": "1639394166",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2414 SHATTUCK AVE",
            "city": "BERKELEY",
            "state": "CA",
            "postal_code": "947042023",
            "telephone_number": "510-843-1228",
            "fax_number": "510-843-2080"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2414 SHATTUCK AVE",
            "city": "BERKELEY",
            "state": "CA",
            "postal_code": "947042023",
            "telephone_number": "510-843-1228",
            "fax_number": "510-843-2080"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARK A FUJIKAWA & STEPHEN R CHUN PTR",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-17",
        "last_updated": "2015-04-20",
        "status": "A",
        "authorized_official_last_name": "FUJIKAWA",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PARTNER",
        "authorized_official_telephone_number": "510-843-1228",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "CA",
            "license": "FNP 393",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Berkeley Optometric Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Berkeley, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2015; 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.