NPIMap

Organization Active NPI

Sylvan Eye Associates, a Medical Corporation

  • Ophthalmology Physician
  • Modesto, CA
National Provider Identifier
1740279207
Registry record updated Jan 25, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
Legal business name
SYLVAN EYE ASSOCIATES, A MEDICAL CORPORATION
Practice address
1011 Sylvan Ave
Suite a
Modesto, CA 95350-1692
Phone
(209) 575-2020
Fax
(209) 758-5693
NPI assigned
Oct 18, 2005
Last updated
Jan 25, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 25, 2011

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

Authorized official

Name
Kerry Alan Horner, ODNPI 1467441931
Title
Vice President
Phone
(209) 575-2020

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X NU
Ophthalmology Physician 207W00000X NU Primary

Addresses

Primary practice location

1011 Sylvan Ave
Suite a
Modesto, CA 95350-1692

Mailing address

1011 Sylvan Ave
Suite a
Modesto, CA 95350-1692
Phone (209) 575-2020

Other identifiers 3

IdentifierTypeStateIssuer
GSD088411MedicaidCA
ZZZ00823ZOtherBLUE SHIELD
GR0088410OtherCAOPTHALMOLOGY MEDICAL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040623001646 CA Part B Supplier - Clinic/Group Practice 5193700920 Receives reassigned benefits from 9 practitioners
Practice locations: Modesto, CA

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 14

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.

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1129593600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1295913600000",
    "number": "1740279207",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1011 SYLVAN AVE",
            "address_2": "SUITE A",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953501692",
            "telephone_number": "209-575-2020",
            "fax_number": "209-758-5693"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1011 SYLVAN AVE",
            "address_2": "SUITE A",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953501692",
            "telephone_number": "209-575-2020",
            "fax_number": "209-758-5693"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SYLVAN EYE ASSOCIATES, A MEDICAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-18",
        "last_updated": "2011-01-25",
        "status": "A",
        "authorized_official_last_name": "HORNER",
        "authorized_official_first_name": "KERRY",
        "authorized_official_middle_name": "ALAN",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "209-575-2020",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GSD088411",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "ZZZ00823Z",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OPTHALMOLOGY MEDICAL",
            "identifier": "GR0088410",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Modesto, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 25, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.