Active NPI
Jean Catherine Church, O.D.
- Optometrist
- Piedmont, CA
National Provider Identifier
1730405606
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 11677T
- Practice address
- 545 Boulevard Way
Piedmont, CA 94610-1524 - Phone
- (510) 387-6787
- NPI assigned
- Apr 15, 2010
- Last updated
- Apr 15, 2010
- Sex
- Female
- 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 | 11677T | CA | Primary |
Addresses
Primary practice location
545 Boulevard Way
Piedmont, CA 94610-1524
Mailing address
545 Boulevard Way
Piedmont, CA 94610-1524
Phone (510) 387-6787
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in DC
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Optometry
- Education
- Pennsylvania College of Optometry, 1997
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
13029 Route 50
Fairfax, VA 22033-2001
Phone (703) 322-2020
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 11677T | CA | MD | Optometrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Greenbriar Vision Center, Inc | Current | Accepting new patients | |
| Regents of the University of California at Berkeley | Optometrist | Past | Accepting new patients |
Locations
13029 Route 50
Fairfax, VA 22033
Phone (703) 322-1220
Organizations & group practices 2
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.
-
- Optometrist
- Berkeley, CA
- NPI 1306908058
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1271289600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1271289600000",
"number": "1730405606",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "545 BOULEVARD WAY",
"city": "PIEDMONT",
"state": "CA",
"postal_code": "946101524",
"telephone_number": "510-387-6787"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "545 BOULEVARD WAY",
"city": "PIEDMONT",
"state": "CA",
"postal_code": "946101524",
"telephone_number": "510-387-6787"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CHURCH",
"first_name": "JEAN",
"middle_name": "CATHERINE",
"name_prefix": "Dr.",
"credential": "O.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2010-04-15",
"last_updated": "2010-04-15",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "CA",
"license": "11677T",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Piedmont, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 15, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.