Active NPI
Howard H Ellenberger, OD, PHD
- Optometrist
- San Rafael, CA
National Provider Identifier
1689755605
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- OPT 13171 T
- Practice address
- 901 A St
Suite C
San Rafael, CA 94901-3043 - Phone
- (415) 453-8906
- NPI assigned
- Oct 17, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | OPT 13171 T | CA | Primary |
Addresses
Primary practice location
901 A St
Suite C
San Rafael, CA 94901-3043
Mailing address
9 Mount Wittenburg CT
San Rafael, CA 94903-1057
Phone (415) 492-8698
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| OPT 13171 T | CA | MD | Optometrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1161043200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1689755605",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9 MOUNT WITTENBURG CT",
"city": "SAN RAFAEL",
"state": "CA",
"postal_code": "949031057",
"telephone_number": "415-492-8698"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "901 A ST",
"address_2": "SUITE C",
"city": "SAN RAFAEL",
"state": "CA",
"postal_code": "949013043",
"telephone_number": "415-453-8906"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ELLENBERGER",
"first_name": "HOWARD",
"middle_name": "H",
"name_prefix": "Dr.",
"credential": "OD, PHD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-10-17",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "CA",
"license": "OPT 13171 T",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Rafael, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.