Active NPI
Robert E Pedersen, O.D.
- Optometrist
- Stockton, CA
National Provider Identifier
1821173972
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- OPT8002TPA
- Practice address
- 255 E Weber Ave
Stockton, CA 95202-2706 - Phone
- (209) 466-5566
- Fax
- (209) 466-5566
- NPI assigned
- Oct 26, 2006
- Sex
- Male
- Sole proprietor
- No
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 | OPT8002TPA | CA | Primary |
Addresses
Primary practice location
255 E Weber Ave
Stockton, CA 95202-2706
Mailing address
255 E Weber Ave
Stockton, CA 95202-2706
Phone (209) 466-5566
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 |
|---|---|---|---|
| OPT8002TPA | CA | MD | Optometrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1161820800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1359590400000",
"number": "1821173972",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "255 E WEBER AVE",
"city": "STOCKTON",
"state": "CA",
"postal_code": "952022706",
"telephone_number": "209-466-5566",
"fax_number": "209-466-0535"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "255 E WEBER AVE",
"city": "STOCKTON",
"state": "CA",
"postal_code": "952022706",
"telephone_number": "209-466-5566",
"fax_number": "209-466-5566"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PEDERSEN",
"first_name": "ROBERT",
"middle_name": "E",
"credential": "O.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-10-26",
"last_updated": "2013-01-31",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "CA",
"license": "OPT8002TPA",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Stockton, CA
- Pearle Visioncare Inc (Pearle Vision #C6007)
- Heather E Pearson, PSY.D.
- Marquetta Pearson
- Anthony Edward Pedalino, PHARM.D.
- Laugatausala Kayla Ann Pedebone
- Pediatric Associates of Stockton
- Pediatric Care of Stockton
- Elio Pedroso Conroy, MD
- Rosa M Pedroza
- Peebles Family Care Home (PALS Assisted Living Services Inc)
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 31, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.