Brian Calvert, O.D.
Individual provider Active NPI Optometrist · Fortuna, CA
NPI 1790778017 · NPPES record last updated May 5, 2008
Key facts
- NPI
- 1790778017
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Optometrist 152W00000X
- License
- 11045 (CA)
- 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
- Sex
- Male
- Sole proprietor
- Yes
Medicare Care Compare profile
- 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 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20041021001101 | CA | Practitioner - Optometry | 7315908415 | Practice locations: Fortuna, CA |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 11045 | CA | MD | Professional Counselor |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 11045 | CA | Yes |
Addresses
Primary practice location
3429 Renner Dr
Fortuna, CA 95540-3104
Mailing address
3429 Renner Dr
Fortuna, CA 95540-3104
Phone (707) 725-5255
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| SD0110451 | Medicaid | CA |
Other providers in Fortuna, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 5, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.