Christopher G Albaugh, OD
Individual provider Active NPI Optometrist · Fontana, CA
NPI 1720155567 · NPPES record last updated Nov 29, 2021
Key facts
- NPI
- 1720155567
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Optometrist 152W00000X
- License
- OPT9691TPA (CA)
- Practice address
- 9961 Sierra Ave
Fontana, CA 92335-6720 - Phone
- (909) 427-3910
- NPI assigned
- Nov 29, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 6
Medicare Care Compare profile
- Specialty
- Optometry
- Education
- Southern California College of Optometry, 1991
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Southern California Permanente Medical Group
Practice addresses (Care Compare)
10850 Arrow Rte
Rancho Cucamonga, CA 91730-4833
Phone (888) 750-0036
9961 Sierra Ave
Fontana, CA 92335-6720
Phone (909) 427-5000
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20050425001066 | CA | Practitioner - Optometry | 1052350568 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| OPT9691TPA | CA | MD | Optometrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Southern California Permanente Medical Group | Current |
Accepting new patients | |
| Southern California Permanente Medical Group | Current |
Accepting new patients | |
| Southern California Permanente Medical Group | Current | Accepting new patients |
Locations
9961 Sierra Ave
Fontana, CA 92335
Phone (909) 427-3910
393 E Walnut St
Fl 3
Pasadena, CA 91188
Phone (626) 405-7914
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | OPT9691TPA | CA | Yes |
Addresses
Primary practice location
9961 Sierra Ave
Fontana, CA 92335-6720
Mailing address
9961 Sierra Ave
Fontana, CA 92335-6720
Phone (909) 427-3910
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| SOAP URL | https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq | Health Information Exchange (HIE) | Southern California Permanente Medical Group |
Other providers in Fontana, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 29, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.