Active NPI
Craig Arthur Van Woerkom, O.D.
- Optometrist
- Pasadena, CA
National Provider Identifier
1811965320
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 11769T
- Practice address
- 960 E Green St
Suite 1000
Pasadena, CA 91106-2401 - Phone
- (626) 793-1483
- Fax
- (626) 793-5449
- NPI assigned
- Mar 9, 2006
- 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 | 11769T | CA | Primary |
Addresses
Primary practice location
960 E Green St
Suite 1000
Pasadena, CA 91106-2401
Mailing address
960 E Green St
Suite 1000
Pasadena, CA 91106-2401
Phone (626) 793-1483
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| W21396 | Other | CA | MEDICARE PTAN |
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 11769T | CA | MD | Optometrist |
| 11769 | CA | MD | Speech-Language Pathologist |
Networks
- BSC 65 PLUS INDIVIDUAL MAPD
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1141862400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1257465600000",
"number": "1811965320",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "960 E GREEN ST",
"address_2": "SUITE 1000",
"city": "PASADENA",
"state": "CA",
"postal_code": "911062401",
"telephone_number": "626-793-1483",
"fax_number": "626-793-5449"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "960 E GREEN ST",
"address_2": "SUITE 1000",
"city": "PASADENA",
"state": "CA",
"postal_code": "911062401",
"telephone_number": "626-793-1483",
"fax_number": "626-793-5449"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VAN WOERKOM",
"first_name": "CRAIG",
"middle_name": "ARTHUR",
"credential": "O.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-03-09",
"last_updated": "2009-11-06",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "CA",
"license": "11769T",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE PTAN",
"identifier": "W21396",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Pasadena, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 6, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.