Eye Associates of Sebastopol Medical Group

Primary specialty

Eyewear SupplierTaxonomy code 332H00000X

License

97-518945 00004 JH Issued in CA

Legal business name

EYE ASSOCIATES OF SEBASTOPOL MEDICAL GROUP

Practice address

14709 Lakeshore Drive
Clearlake, CA 95422-5539

Phone

(707) 994-8644

Fax

(707) 994-5015

NPI assigned

Oct 9, 2008

Last updated

Oct 9, 2008By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Eric J Kahle, MD

Title

Owner

Phone

(707) 823-7628

Specialties & licenses 1

Addresses

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Tax ID family

Eye Associates of Sebastopol Medical Group Inc3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

• Eye Associates of Sebastopol Medical Group

  • Eyewear Supplier
  • Santa Rosa, CA
  • NPI 1598800419
  NPD tax ID
• Eye Associates of Sebastopol Medical Group

  • Eyewear Supplier
  • Sebastopol, CA
  • NPI 1619012119
  NPD tax ID

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

{
    "created_epoch": "1223510400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1223510400000",
    "number": "1770734659",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 5539",
            "city": "CLEARLAKE",
            "state": "CA",
            "postal_code": "954225539",
            "telephone_number": "707-994-8644",
            "fax_number": "707-994-5015"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14709 LAKESHORE DRIVE",
            "city": "CLEARLAKE",
            "state": "CA",
            "postal_code": "954225539",
            "telephone_number": "707-994-8644",
            "fax_number": "707-994-5015"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EYE ASSOCIATES OF SEBASTOPOL MEDICAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-10-09",
        "last_updated": "2008-10-09",
        "status": "A",
        "authorized_official_last_name": "KAHLE",
        "authorized_official_first_name": "ERIC",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "707-823-7628",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "332H00000X",
            "taxonomy_group": "",
            "desc": "Eyewear Supplier",
            "state": "CA",
            "license": "97-518945 00004 JH",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Janet M Edmonds, COUNSELOR CAS, RAS
• Malka Rhonda Eisgrau, LPC, LPN
• Peter Monroe Eliot
• Jack M Elizares, O.D.
• Tia Ellis
• Daniel Feeney
• Delmer Fjarli, M.D.
• Debra Marie Fleming, RASI
• Angelic Julia Flores
• Yolanda Estella Flores, PSYCHIATRIC TECHNICI

• Eyewear Supplier in Clearlake, CA
• Providers in Clearlake, CA by specialty
• Eyewear Supplier in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 9, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• 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.

Verify at the official NPI Registry.