NPIMap

Organization Active NPI

Ragsdale & Clayton Optometric Centers, Inc.

  • Optometrist
  • Moreno Valley, CA
National Provider Identifier
1770901613
Registry record updated Mar 28, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
12701T Issued in CA
Legal business name
RAGSDALE & CLAYTON OPTOMETRIC CENTERS, INC.
Practice address
23000 Atlantic Cir
Moreno Valley, CA 92553-5990
Phone
(951) 924-1877
Fax
(951) 485-3580
NPI assigned
Mar 28, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 28, 2014

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

Authorized official

Name
Mr. Ethan Mackenzie Clayton, ODNPI 1629130257
Title
Owner
Phone
(951) 924-1877

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
OptometristGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 152W00000X 12701T CA Primary
OptometristGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 152W00000X 10009T CA

Addresses

Primary practice location

23000 Atlantic Cir
Moreno Valley, CA 92553-5990

Mailing address

23000 Atlantic Cir
Moreno Valley, CA 92553-5990
Phone (951) 924-1877

Other names 1

  • Optometric Centers Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20141115000256 CA Part B Supplier - Clinic/Group Practice 9537381132 Receives reassigned benefits from 4 practitioners
Practice locations: Riverside, CA; Moreno Valley, CA

National Provider Directory

National Provider Directory

Locations

23000 Atlantic Cir
Moreno Valley, CA 92553
Phone (951) 924-1877

3674 Sunnyside Dr
Ste 2
Riverside, CA 92506
Phone (951) 684-4646

Practitioners & affiliated clinicians

Practitioners 5

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": "1395964800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1395964800000",
    "number": "1770901613",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "23000 ATLANTIC CIR",
            "city": "MORENO VALLEY",
            "state": "CA",
            "postal_code": "925535990",
            "telephone_number": "951-924-1877",
            "fax_number": "951-485-3580"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "23000 ATLANTIC CIR",
            "city": "MORENO VALLEY",
            "state": "CA",
            "postal_code": "925535990",
            "telephone_number": "951-924-1877",
            "fax_number": "951-485-3580"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RAGSDALE & CLAYTON OPTOMETRIC CENTERS, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-03-28",
        "last_updated": "2014-03-28",
        "status": "A",
        "authorized_official_last_name": "CLAYTON",
        "authorized_official_first_name": "ETHAN",
        "authorized_official_middle_name": "MACKENZIE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "951-924-1877",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": "CA",
            "license": "12701T",
            "primary": true
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": "CA",
            "license": "10009T",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Optometric Centers",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Moreno Valley, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 28, 2014; 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.