Active NPI
Brian Calvert, O.D.
- Optometrist
- Fortuna, CA
National Provider Identifier
1790778017
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 11045
- Practice address
- 3429 Renner Dr
Fortuna, CA 95540-3104 - Phone
- (707) 725-5255
- Fax
- (707) 725-8833
- NPI assigned
- Aug 23, 2005
- Reactivated
- Apr 12, 2006
- Last updated
- May 5, 2008
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 11045 | CA | Primary |
Addresses
Primary practice location
3429 Renner Dr
Fortuna, CA 95540-3104
Mailing address
3429 Renner Dr
Fortuna, CA 95540-3104
Phone (707) 725-5255
Medicare participation
Medicare enrollment files- 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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20041021001101 | CA | Practitioner - Optometry | 7315908415 | Practice locations: Fortuna, CA |
Care Compare profile
Medicare Care Compare- Specialty
- Optometry
- Education
- University of California - School of Optometry, 1998
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
777 9TH St
Fortuna, CA 95540-2001
Phone (707) 725-5255
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Cataract surgery | 1-10 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 11045 | CA | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1124755200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1209945600000",
"number": "1790778017",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3429 RENNER DR",
"city": "FORTUNA",
"state": "CA",
"postal_code": "955403104",
"telephone_number": "707-725-5255",
"fax_number": "707-725-8833"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3429 RENNER DR",
"city": "FORTUNA",
"state": "CA",
"postal_code": "955403104",
"telephone_number": "707-725-5255",
"fax_number": "707-725-8833"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CALVERT",
"first_name": "BRIAN",
"credential": "O.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2005-08-23",
"last_updated": "2008-05-05",
"deactivation_date": "2006-03-27",
"reactivation_date": "2006-04-12",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "CA",
"license": "11045",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fortuna, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 5, 2008; 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.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.