Active NPI
Stacie Delilah Calvillo, O.D.
- Optometrist
- Cerritos, CA
National Provider Identifier
1689959330
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 15228
- Practice address
- 11805 South St
Cerritos, CA 90703-6825 - Phone
- (562) 860-4475
- NPI assigned
- Oct 13, 2011
- Sex
- Female
- 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 | 15228 | CA | Primary |
Addresses
Primary practice location
11805 South St
Cerritos, CA 90703-6825
Mailing address
20144 Mapes Ave
Cerritos, CA 90703-6564
Phone (916) 798-6913
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1318464000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1495756800000",
"number": "1689959330",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "20144 MAPES AVE",
"city": "CERRITOS",
"state": "CA",
"postal_code": "907036564",
"telephone_number": "916-798-6913"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11805 SOUTH ST",
"city": "CERRITOS",
"state": "CA",
"postal_code": "907036825",
"telephone_number": "562-860-4475"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CALVILLO",
"first_name": "STACIE",
"middle_name": "DELILAH",
"credential": "O.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-10-13",
"last_updated": "2017-05-26",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "CA",
"license": "15228",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Cerritos, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 26, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.