Active NPI
Eduardita Eolani Vicencio, M.D.
- Ophthalmology Physician
- Apple Valley, CA
National Provider Identifier
1790903573
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Ophthalmology Physician
- License
- A23710
- Practice address
- 16031 Tuscola Rd
Apple Valley, CA 92307-1319 - Phone
- (760) 946-2020
- NPI assigned
- Apr 24, 2007
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Ophthalmology Physician | 207W00000X | A23710 | CA | Primary |
Addresses
Primary practice location
16031 Tuscola Rd
Apple Valley, CA 92307-1319
Mailing address
16031 Tuscola Rd
Apple Valley, CA 92307-1319
Phone (760) 946-2020
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00A237100 | Medicaid | CA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| A23710 | CA | MD | Ophthalmology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1177372800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1412553600000",
"number": "1790903573",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "16031 TUSCOLA RD",
"city": "APPLE VALLEY",
"state": "CA",
"postal_code": "923071319",
"telephone_number": "760-946-2020"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "16031 TUSCOLA RD",
"city": "APPLE VALLEY",
"state": "CA",
"postal_code": "923071319",
"telephone_number": "760-946-2020"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VICENCIO",
"first_name": "EDUARDITA",
"middle_name": "EOLANI",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-04-24",
"last_updated": "2014-10-06",
"status": "A"
},
"taxonomies": [
{
"code": "207W00000X",
"taxonomy_group": "",
"desc": "Ophthalmology",
"state": "CA",
"license": "A23710",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00A237100",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Apple Valley, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 6, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.