Nicole Kelsy Antonio, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

35566 Issued in CA

Practice address

809 Sylvan Ave Ste 103
Modesto, CA 95350-1500

Phone

(209) 524-0100

NPI assigned

May 18, 2022

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Optometry

Education

Pacific University - College of Optometry, 2023

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Keith David Kajioka, O.D.

  • Optometrist
  • Modesto, CA
  • NPI 1053370825
  Medicare reassignment

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

{
    "created_epoch": "1652832000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1704672000000",
    "number": "1699412841",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2020 CANYON LAKE DR",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953551887",
            "telephone_number": "808-640-0363"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "809 SYLVAN AVE STE 103",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953501500",
            "telephone_number": "209-524-0100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANTONIO",
        "first_name": "NICOLE",
        "middle_name": "KELSY",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-05-18",
        "last_updated": "2024-01-08",
        "certification_date": "2024-01-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "35566",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Anthony H. Tran,DDS & Emily Nguyen,DDS, Inc.,
• David Anthony, CMT
• Nesren Anton Azer Anton, NP
• Antonio K Coirin M.D. Inc.
• Lani Domingo Antonio II, PA
• Ashley Danica Antovich, MD
• Anuradha Dubey, M.D., Inc
• Maria Anwar
• Mehtab Anwar
• Muhammad U. Anwar, MD

• Optometrist in Modesto, CA
• Providers in Modesto, CA by specialty
• Optometrist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 8, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.