Individual provider Active NPI

Randall Ray McPherran, OD

  • Optometrist
  • Paradise, CA
National Provider Identifier
1720001738
Registry record updated Jun 11, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
OPT9153TPG Issued in CA
Practice address
6283 Clark Rd
#10
Paradise, CA 95969-4100
Phone
(530) 877-2020
Fax
(530) 877-4146
NPI assigned
Jul 25, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 11, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X OPT9153TPG CA Primary

Addresses

Primary practice location

6283 Clark Rd
#10
Paradise, CA 95969-4100

Mailing address

6283 Clark Rd
#10
Paradise, CA 95969-4100
Phone (530) 877-2020

Other identifiers 1

IdentifierTypeStateIssuer
SD0091530MedicaidCA

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
I20050108000116 CA Practitioner - Optometry 5092763805 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Alameda Health System CurrentSince May 26, 2015 Accepting new patients
Alameda Health System CurrentSince May 26, 2015 Accepting new patients
Alameda Health System Current Accepting new patients
Jerome WH Niswonger MD Inc Optometrist Past Accepting new patients

Locations

664 Southland Mall
Hayward, CA 94545
Phone (510) 266-1700

6066 Civic Terrace Ave
Newark, CA 94560
Phone (510) 505-1600

1411 E 31st St
Oakland, CA 94602
Phone (510) 437-4323

6955 Foothill Blvd
Ste 200
Oakland, CA 94605
Phone (510) 567-5700

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1153785600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1339372800000",
    "number": "1720001738",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6283 CLARK RD",
            "address_2": "#10",
            "city": "PARADISE",
            "state": "CA",
            "postal_code": "959694100",
            "telephone_number": "530-877-2020",
            "fax_number": "530-877-4146"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6283 CLARK RD",
            "address_2": "#10",
            "city": "PARADISE",
            "state": "CA",
            "postal_code": "959694100",
            "telephone_number": "530-877-2020",
            "fax_number": "530-877-4146"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCPHERRAN",
        "first_name": "RANDALL",
        "middle_name": "RAY",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-25",
        "last_updated": "2012-06-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "OPT9153TPG",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "SD0091530",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Paradise, CA

Sources for this page

Verify at the official NPI Registry.