NPIMap

Organization Active NPI

Oakland Vision Center

  • Optometrist
  • Oakland, CA
National Provider Identifier
1699885012
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
COR 158 Issued in CA
Legal business name
OAKLAND VISION CENTER
Practice address
1960 Broadway
Oakland, CA 94612-2206
Phone
(510) 893-5566
Fax
(510) 893-3921
NPI assigned
Aug 30, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Mr. Carl A Grondona, O.D.
Title
President
Phone
(510) 893-5566

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X COR 158 CA Primary

Addresses

Primary practice location

1960 Broadway
Oakland, CA 94612-2206

Mailing address

1960 Broadway
Oakland, CA 94612-2206
Phone (510) 893-5566

Other identifiers 1

IdentifierTypeStateIssuer
GSD000070MedicaidCA

National Provider Directory

National Provider Directory

Locations

1960 Broadway
Oakland, CA 94612
Phone (510) 893-5566

Practitioners & affiliated clinicians

Practitioners 12

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1156896000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1699885012",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1960 BROADWAY",
            "city": "OAKLAND",
            "state": "CA",
            "postal_code": "946122206",
            "telephone_number": "510-893-5566",
            "fax_number": "510-893-3921"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1960 BROADWAY",
            "city": "OAKLAND",
            "state": "CA",
            "postal_code": "946122206",
            "telephone_number": "510-893-5566",
            "fax_number": "510-893-3921"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OAKLAND VISION CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-30",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "GRONDONA",
        "authorized_official_first_name": "CARL",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "510-893-5566",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "COR 158",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GSD000070",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Oakland, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.