NPIMap

Organization Active NPI

Dean Amundsen,O.D. Professional Optometry Corp.

  • Optometrist
  • Camarillo, CA
National Provider Identifier
1750353637
Registry record updated Aug 4, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
OPT7925TPA Issued in CA
Legal business name
DEAN AMUNDSEN,O.D. PROFESSIONAL OPTOMETRY CORP.
Practice address
4000 Calle Tecate
Suite 100
Camarillo, CA 93012-5282
Phone
(805) 482-1136
NPI assigned
Feb 3, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 4, 2008

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

Authorized official

Name
Dr. Dean Kenton Amundsen, O.D.NPI 1003021205
Title
President/Ceo
Phone
(805) 482-1136

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X OPT7925TPA CA Primary

Addresses

Primary practice location

4000 Calle Tecate
Suite 100
Camarillo, CA 93012-5282

Mailing address

4000 Calle Tecate
Suite 100
Camarillo, CA 93012-5282

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031124000761 CA Part B Supplier - Clinic/Group Practice 8527962232 Receives reassigned benefits from 5 practitioners
Practice locations: Camarillo, CA

National Provider Directory

National Provider Directory

Locations

4000 Calle Tecate
Ste 100
Camarillo, CA 93012
Phone (805) 482-1136

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1138924800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1217808000000",
    "number": "1750353637",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4000 CALLE TECATE",
            "address_2": "SUITE 100",
            "city": "CAMARILLO",
            "state": "CA",
            "postal_code": "930125282"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4000 CALLE TECATE",
            "address_2": "SUITE 100",
            "city": "CAMARILLO",
            "state": "CA",
            "postal_code": "930125282",
            "telephone_number": "805-482-1136"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DEAN AMUNDSEN,O.D. PROFESSIONAL OPTOMETRY CORP.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-02-03",
        "last_updated": "2008-08-04",
        "status": "A",
        "authorized_official_last_name": "AMUNDSEN",
        "authorized_official_first_name": "DEAN",
        "authorized_official_middle_name": "KENTON",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "805-482-1136",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "CA",
            "license": "OPT7925TPA",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Camarillo, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 4, 2008; 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.