NPIMap

Organization Active NPI

Spectrum Eyecare Optometry Inc

  • Optometrist
  • San Dimas, CA
National Provider Identifier
1801949573
Registry record updated Jan 10, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
11528T Issued in CA
Legal business name
SPECTRUM EYECARE OPTOMETRY INC
Practice address
425 W Bonita Ave
Suite 110B
San Dimas, CA 91773-2541
Phone
(909) 394-0462
NPI assigned
Jan 18, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 10, 2012

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

Authorized official

Name
Dr. David Ashley Swearingen, ODNPI 1912964834
Title
President and Cfo
Phone
(909) 394-0462

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
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X 11528T CA Primary

Addresses

Primary practice location

425 W Bonita Ave
Suite 110B
San Dimas, CA 91773-2541

Mailing address

425 W Bonita Ave
Suite 110B
San Dimas, CA 91773-2541
Phone (909) 394-0462

Other identifiers 4

IdentifierTypeStateIssuer
5892280001OtherCAPTAN
W20601OtherCAMEDICARE GROUP NUMBER
DF7961OtherCARAILROAD GROUP NUMBER
P00393465OtherCARAILROAD PTAN

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070503000592 CA Part B Supplier - Clinic/Group Practice 5193821353 Receives reassigned benefits from 25 practitioners
Practice locations: San Bernardino, CA; San Dimas, CA

National Provider Directory

National Provider Directory

Locations

425 W Bonita Ave
Ste 110B
San Dimas, CA 91773
Phone (909) 394-0462

Practitioners & affiliated clinicians

Practitioners 35

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 35

NPI Registry JSON

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

{
    "created_epoch": "1169078400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1326153600000",
    "number": "1801949573",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "425 W BONITA AVE",
            "address_2": "SUITE 110B",
            "city": "SAN DIMAS",
            "state": "CA",
            "postal_code": "917732541",
            "telephone_number": "909-394-0462"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "425 W BONITA AVE",
            "address_2": "SUITE 110B",
            "city": "SAN DIMAS",
            "state": "CA",
            "postal_code": "917732541",
            "telephone_number": "909-394-0462"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPECTRUM EYECARE OPTOMETRY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-18",
        "last_updated": "2012-01-10",
        "status": "A",
        "authorized_official_last_name": "SWEARINGEN",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "ASHLEY",
        "authorized_official_title_or_position": "PRESIDENT AND CFO",
        "authorized_official_telephone_number": "909-394-0462",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "CA",
            "license": "11528T",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PTAN",
            "identifier": "5892280001",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP NUMBER",
            "identifier": "W20601",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD GROUP NUMBER",
            "identifier": "DF7961",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD PTAN",
            "identifier": "P00393465",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in San Dimas, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 10, 2012; 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.