Individual provider Active NPI

Terilyn T Thach, O.D.

  • Optometrist
  • Escondido, CA
National Provider Identifier
1710030861
Registry record updated Jul 15, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
11456T Issued in CA
Practice address
2419 E Valley Pkwy
Escondido, CA 92027-2932
Phone
(760) 729-4696
NPI assigned
Jan 20, 2007
Last updated
Jul 15, 2011By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 15, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 11456T CA Primary

Addresses

Primary practice location

2419 E Valley Pkwy
Escondido, CA 92027-2932

Mailing address

2419 E Valley Pkwy
Escondido, CA 92027-2932

Other identifiers 1

IdentifierTypeStateIssuer
1593639MedicaidCA

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20071101000735 CA Practitioner - Optometry 6305933631 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
University of California - School of Optometry, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

2419 E Valley Pkwy
Escondido, CA 92027-2932
Phone (760) 738-9931

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
11456TCAMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Terilyn Thach, Inc Optometrist CurrentSince Oct 10, 2010 Accepting new patients

Locations

2419 E Valley Pkwy
Escondido, CA 92027
Phone (760) 729-4696

Organizations & group practices 1

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

NPI Registry JSON

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

{
    "created_epoch": "1169251200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1310688000000",
    "number": "1710030861",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2419 E VALLEY PKWY",
            "city": "ESCONDIDO",
            "state": "CA",
            "postal_code": "920272932"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2419 E VALLEY PKWY",
            "city": "ESCONDIDO",
            "state": "CA",
            "postal_code": "920272932",
            "telephone_number": "760-729-4696"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THACH",
        "first_name": "TERILYN",
        "middle_name": "T",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-20",
        "last_updated": "2011-07-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "11456T",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1593639",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Escondido, CA

Sources for this page

Verify at the official NPI Registry.