Individual provider Active NPI

Daniel L Sanders, O.D.

  • Optometrist
  • El Cerrito, CA
National Provider Identifier
1649321340
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
4568T Issued in CA
Practice address
11780 San Pablo Ave
Suite B
El Cerrito, CA 94530-2231
Phone
(510) 234-1730
Fax
(510) 234-8841
NPI assigned
Jan 16, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 4568T CA Primary

Addresses

Primary practice location

11780 San Pablo Ave
Suite B
El Cerrito, CA 94530-2231

Mailing address

11780 San Pablo Ave
Suite B
El Cerrito, CA 94530-2231
Phone (510) 234-1730

Other identifiers 1

IdentifierTypeStateIssuer
SD0045680MedicaidCA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
Eligible to order & refer
  • Part B services: No
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
4568TCAMDOptometrist

NPI Registry JSON

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

{
    "created_epoch": "1168905600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1649321340",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11780 SAN PABLO AVE",
            "address_2": "SUITE B",
            "city": "EL CERRITO",
            "state": "CA",
            "postal_code": "945302231",
            "telephone_number": "510-234-1730",
            "fax_number": "510-234-8841"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11780 SAN PABLO AVE",
            "address_2": "SUITE B",
            "city": "EL CERRITO",
            "state": "CA",
            "postal_code": "945302231",
            "telephone_number": "510-234-1730",
            "fax_number": "510-234-8841"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SANDERS",
        "first_name": "DANIEL",
        "middle_name": "L",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-16",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "4568T",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "SD0045680",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in El Cerrito, CA

Sources for this page

Verify at the official NPI Registry.