Capital Eye Medical Group

Primary specialty

Ophthalmology PhysicianTaxonomy code 207W00000X

Legal business name

CAPITAL EYE MEDICAL GROUP

Practice address

123 Margaret LN Ste A1
Grass Valley, CA 95945-5268

Phone

(530) 615-3775

Fax

(530) 298-9223

NPI assigned

Sep 14, 2019

Last updated

Apr 9, 2023By 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

Mitra Ayazifar, MDNPI 1972520641

Title

Owner

Phone

(916) 960-9176

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Other NPIs on the same Medicare enrollment 2

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

• Capital Eye Medical Group

  • Ophthalmology Physician
  • Jackson, CA
  • NPI 1568893659

  O20111209000146

  Same enrollment
• Capital Eye Medical Group

  • Ophthalmology Physician
  • Roseville, CA
  • NPI 1962783928

  O20111209000146

  Same enrollment

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Mitra Ayazifar, MD

  • Ophthalmology Physician
  • Roseville, CA
  • NPI 1972520641
  NPD Authorized official

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

{
    "created_epoch": "1568419200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1680998400000",
    "number": "1780234419",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 279",
            "city": "ROSEVILLE",
            "state": "CA",
            "postal_code": "95660",
            "telephone_number": "916-960-9176"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "123 MARGARET LN STE A1",
            "city": "GRASS VALLEY",
            "state": "CA",
            "postal_code": "959455268",
            "telephone_number": "530-615-3775",
            "fax_number": "530-298-9223"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "360 Sierra College Dr Ste 100",
            "address_purpose": "LOCATION",
            "city": "Grass Valley",
            "state": "CA",
            "postal_code": "959455088",
            "country_code": "US",
            "telephone_number": "530-271-2282",
            "fax_number": "530-271-2287",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "CAPITAL EYE MEDICAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-09-14",
        "last_updated": "2023-04-09",
        "certification_date": "2023-04-09",
        "status": "A",
        "authorized_official_last_name": "AYAZIFAR",
        "authorized_official_first_name": "MITRA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "916-960-9176",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shannon Campbell
• Spencer T Campbell, MFT
• Stuart Benjamin Campbell, M.D.
• Katrina Canham
• Jennie Cano
• Andria Carlson
• Chris R Carlson
• Janette Marie Carpenter, M.D.
• Samuel J. Carroll
• Carrie Carter, PT

• Ophthalmology Physician in Grass Valley, CA
• Providers in Grass Valley, CA by specialty
• Ophthalmology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 9, 2023; 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.