NPIMap

Organization Active NPI

Kennedy & Young Optometry

  • Optometrist
  • Modesto, CA
National Provider Identifier
1639744238
Registry record updated May 25, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
Legal business name
KENNEDY & YOUNG OPTOMETRY
Practice address
1401 Sylvan Ave
Modesto, CA 95355-1367
Phone
(209) 527-6640
NPI assigned
May 25, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 25, 2021

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

Authorized official

Name
Trisha Frick
Title
Billing Specialist
Phone
(209) 527-6640

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193200000X MULTI-SPECIALTY GROUP 152W00000X Primary

Addresses

Primary practice location

1401 Sylvan Ave
Modesto, CA 95355-1367

Mailing address

1401 Sylvan Ave
Modesto, CA 95355-1367
Phone (209) 527-6640

Other names 1

  • VALLEY OPTOMETRIC GROUP Doing business as

National Provider Directory

National Provider Directory

Locations

1401 Sylvan Ave
Modesto, CA 95355
Phone (209) 527-6640

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1621900800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1621900800000",
    "number": "1639744238",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1401 SYLVAN AVE",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953551367",
            "telephone_number": "209-527-6640"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1401 SYLVAN AVE",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953551367",
            "telephone_number": "209-527-6640"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KENNEDY & YOUNG OPTOMETRY",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-05-25",
        "last_updated": "2021-05-25",
        "certification_date": "2021-05-25",
        "status": "A",
        "authorized_official_last_name": "FRICK",
        "authorized_official_first_name": "TRISHA",
        "authorized_official_title_or_position": "BILLING SPECIALIST",
        "authorized_official_telephone_number": "209-527-6640"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "VALLEY OPTOMETRIC GROUP",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Modesto, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 25, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.