NPIMap

Organization Active NPI

Greenhaven Optometry

  • Corneal and Contact Management Optometrist
  • Sacramento, CA
National Provider Identifier
1639426273
Registry record updated May 15, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Corneal and Contact Management OptometristTaxonomy code 152WC0802X
License
CA OPT 6310 TPL Issued in CA
Legal business name
GREENHAVEN OPTOMETRY
Practice address
7410 Greenhaven Drive
Suite 140
Sacramento, CA 95831-5165
Phone
(916) 421-1278
Fax
(916) 421-5055
NPI assigned
Aug 14, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 15, 2013

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

Authorized official

Name
Dr. Steven G. Omoto, O.D.NPI 1710054853
Title
Co-Owner
Phone
(916) 421-1278

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
Corneal and Contact Management OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152WC0802X CA OPT 6310 TPL CA Primary

Addresses

Primary practice location

7410 Greenhaven Drive
Suite 140
Sacramento, CA 95831-5165

Mailing address

7410 Greenhaven Drive
Suite 140
Sacramento, CA 95831-5165
Phone (916) 421-1278

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20130514000331 CA Part B Supplier - Clinic/Group Practice 2769628460 Receives reassigned benefits from 5 practitioners
Practice locations: Sacramento, CA

National Provider Directory

National Provider Directory

Locations

7410 Greenhaven Dr
Ste 140
Sacramento, CA 95831
Phone (916) 421-1278

Practitioners & affiliated clinicians

Practitioners 5

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": "1344902400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1368576000000",
    "number": "1639426273",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7410 GREENHAVEN DRIVE",
            "address_2": "SUITE 140",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958315165",
            "telephone_number": "916-421-1278",
            "fax_number": "916-421-5055"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7410 GREENHAVEN DRIVE",
            "address_2": "SUITE 140",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958315165",
            "telephone_number": "916-421-1278",
            "fax_number": "916-421-5055"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREENHAVEN OPTOMETRY",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-08-14",
        "last_updated": "2013-05-15",
        "status": "A",
        "authorized_official_last_name": "OMOTO",
        "authorized_official_first_name": "STEVEN",
        "authorized_official_middle_name": "G.",
        "authorized_official_title_or_position": "CO-OWNER",
        "authorized_official_telephone_number": "916-421-1278",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152WC0802X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist, Corneal and Contact Management",
            "state": "CA",
            "license": "CA OPT 6310 TPL",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Sacramento, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 15, 2013; 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.