Jean A Neeley, OD
Individual provider Active NPI Optometrist · Calistoga, CA
NPI 1659342020 · NPPES record last updated Aug 7, 2014
Key facts
- NPI
- 1659342020
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Optometrist 152W00000X
- License
- 9321T (CA)
- Practice address
- 1220 Washington St
Calistoga, CA 94515-1450 - Phone
- (707) 942-4674
- Fax
- (707) 942-0745
- NPI assigned
- Feb 1, 2006
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20100310000122 | CA | Practitioner - Optometry | 7214072677 | Practice locations: Calistoga, CA |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 9321T | CA | MD | Optometrist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 9321T | CA | Yes |
Addresses
Primary practice location
1220 Washington St
Calistoga, CA 94515-1450
Mailing address
1220 Washington St
Calistoga, CA 94515-1450
Phone (707) 942-4674
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| SD0093210 | Medicaid | CA |
Other providers in Calistoga, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 7, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.