Jessica Mercado Archambault, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

14819 Issued in CA

Practice address

12759 Foothill Blvd Ste D
Rancho Cucamonga, CA 91739-9336

Phone

(909) 899-0026

NPI assigned

Feb 13, 2014

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Justin T Abo O D a Professional Corporation

  • Optometrist
  • Rancho Cucamonga, CA
  • NPI 1588771380
  Medicare reassignment
• Justin T. Abo, O.D.

  • Optometrist
  • Rancho Cucamonga, CA
  • NPI 1508944711
  NPD (past)

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

{
    "created_epoch": "1392249600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1409788800000",
    "number": "1780008508",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12759 FOOTHILL BLVD",
            "address_2": "SUITE D",
            "city": "RANCHO CUCAMONGA",
            "state": "CA",
            "postal_code": "917399336"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12759 FOOTHILL BLVD STE D",
            "city": "RANCHO CUCAMONGA",
            "state": "CA",
            "postal_code": "917399336",
            "telephone_number": "909-899-0026"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ARCHAMBAULT",
        "first_name": "JESSICA",
        "middle_name": "MERCADO",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-02-13",
        "last_updated": "2014-09-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "14819",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ana Cecilia Arce, LMFT
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• Destiny Arceo
• Maraya Elizabeth Arceo
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• Madelyn Archibald
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• Salvador Ardon, PH.D.,LMFT

• Optometrist in Rancho Cucamonga, CA
• Providers in Rancho Cucamonga, CA by specialty
• Optometrist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 4, 2014; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.