NPIMap

Organization Active NPI

Advanced Vision Group, Inc.

Doing business as Advanced Vision Optometry

  • Optometrist
  • Santa Rosa, CA
National Provider Identifier
1790200624
Registry record updated Sep 25, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
14545 Issued in CA
Legal business name
ADVANCED VISION GROUP, INC.
Doing business as
Advanced Vision Optometry
Dr. Erica Wu Optometry
Practice address
2655 Cleveland Ave Ste a
Santa Rosa, CA 95403-2779
Phone
(707) 542-8883
Fax
(707) 546-7787
NPI assigned
Aug 11, 2017
Last updated
Sep 25, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 25, 2019

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

Authorized official

Name
Dr. Erica Wu, O.D.NPI 1912241761
Title
Ceo
Phone
(530) 902-0271

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
Optometrist 152W00000X 14545 CA Primary

Addresses

Primary practice location

2655 Cleveland Ave Ste a
Santa Rosa, CA 95403-2779

Mailing address

2655 Cleveland Ave Ste a
Santa Rosa, CA 95403-2779
Phone (707) 542-8883

Other practice location 1

479 University Ave
Palo Alto, CA 94301-1814
Phone (650) 327-2020

Other names 2

  • Advanced Vision Optometry Doing business as
  • Dr. Erica Wu Optometry Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20171106003021 CA Part B Supplier - Clinic/Group Practice 0244596369 Receives reassigned benefits from 4 practitioners
Practice locations: Santa Rosa, CA

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1502409600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1569369600000",
    "number": "1790200624",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2655 CLEVELAND AVE STE A",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954032779",
            "telephone_number": "707-542-8883",
            "fax_number": "707-546-7787"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2655 CLEVELAND AVE STE A",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954032779",
            "telephone_number": "707-542-8883",
            "fax_number": "707-546-7787"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "479 University Ave",
            "address_purpose": "LOCATION",
            "city": "Palo Alto",
            "state": "CA",
            "postal_code": "943011814",
            "country_code": "US",
            "telephone_number": "650-327-2020",
            "fax_number": "650-327-2039",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "ADVANCED VISION GROUP, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-08-11",
        "last_updated": "2019-09-25",
        "status": "A",
        "authorized_official_last_name": "WU",
        "authorized_official_first_name": "ERICA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "530-902-0271",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "14545",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Advanced Vision Optometry",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Dr. Erica Wu Optometry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Santa Rosa, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 25, 2019; 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.