Active NPI
Nathan Abraham Forman, OD
- Optometrist
- Fullerton, CA
National Provider Identifier
1699507954
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 35813
- Practice address
- 1508 Windsor LN
Fullerton, CA 92831-2224 - Phone
- (562) 370-0320
- NPI assigned
- Aug 15, 2024
- Last updated
- Aug 15, 2024
- 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 | 35813 | CA | Primary |
Addresses
Primary practice location
1508 Windsor LN
Fullerton, CA 92831-2224
Mailing address
1508 Windsor LN
Fullerton, CA 92831-2224
Phone (562) 370-0320
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 35813 | CA | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1723680000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1723680000000",
"number": "1699507954",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1508 WINDSOR LN",
"city": "FULLERTON",
"state": "CA",
"postal_code": "928312224",
"telephone_number": "562-370-0320"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1508 WINDSOR LN",
"city": "FULLERTON",
"state": "CA",
"postal_code": "928312224",
"telephone_number": "562-370-0320"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FORMAN",
"first_name": "NATHAN",
"middle_name": "ABRAHAM",
"name_prefix": "Dr.",
"credential": "OD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2024-08-15",
"last_updated": "2024-08-15",
"certification_date": "2024-08-13",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "CA",
"license": "35813",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fullerton, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 15, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.