NPIMap

Organization Active NPI

Etwaru Eye Center

  • Ophthalmology Physician
  • Pleasant Hill, CA
National Provider Identifier
1780045658
Registry record updated Mar 18, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
Legal business name
ETWARU EYE CENTER
Practice address
395 Civic Dr
Suite G
Pleasant Hill, CA 94523-1979
Phone
(925) 676-8365
Fax
(925) 954-6939
NPI assigned
Mar 18, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 18, 2016

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

Authorized official

Name
Dr. Gupta Etwaru, MDNPI 1790733913
Title
Owner
Phone
(925) 676-8365

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
Ophthalmology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207W00000X Primary

Addresses

Primary practice location

395 Civic Dr
Suite G
Pleasant Hill, CA 94523-1979

Mailing address

395 Civic Dr
Suite G
Pleasant Hill, CA 94523-1979
Phone (925) 676-8365

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20190515001725 CA Part B Supplier - Clinic/Group Practice 7618210659 Receives reassigned benefits from 3 practitioners
Practice locations: Martinez, CA

National Provider Directory

National Provider Directory
Tax ID family
Etwaru Eye Center2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Locations

395 Civic Dr
Ste G
Pleasant Hill, CA 94523
Phone (925) 676-8365

Practitioners & affiliated clinicians

Practitioners 8

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": "1458259200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1458259200000",
    "number": "1780045658",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "395 CIVIC DR",
            "address_2": "SUITE G",
            "city": "PLEASANT HILL",
            "state": "CA",
            "postal_code": "945231979",
            "telephone_number": "925-676-8365",
            "fax_number": "925-954-6939"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "395 CIVIC DR",
            "address_2": "SUITE G",
            "city": "PLEASANT HILL",
            "state": "CA",
            "postal_code": "945231979",
            "telephone_number": "925-676-8365",
            "fax_number": "925-954-6939"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ETWARU EYE CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-03-18",
        "last_updated": "2016-03-18",
        "status": "A",
        "authorized_official_last_name": "ETWARU",
        "authorized_official_first_name": "GUPTA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "925-676-8365",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Ophthalmology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pleasant Hill, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 18, 2016; 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.