Douglas a Liddicoat Inc

Primary specialty

Ophthalmology PhysicianTaxonomy code 207W00000X

License

C19432 Issued in CA

Legal business name

DOUGLAS A LIDDICOAT INC

Practice address

160 Green Valley Rd
Suite 202
Freedom, CA 95019-3160

Phone

(831) 728-2020

Fax

(831) 728-4739

NPI assigned

Jun 1, 2007

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Douglas A Liddicoat, MD

Title

President

Phone

(831) 728-2020

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Lawrence A Birndorf, MD

  • Ophthalmology Physician
  • Freedom, CA
  • NPI 1558450932
  NPD (past)
• Careen Caputo, OD

  • Optometrist
  • Hollister, CA
  • NPI 1104926393
  NPD (past)

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

{
    "created_epoch": "1180656000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1831391937",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "160 GREEN VALLEY RD",
            "address_2": "SUITE 202",
            "city": "FREEDOM",
            "state": "CA",
            "postal_code": "950193160",
            "telephone_number": "831-728-2020",
            "fax_number": "831-728-4739"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "160 GREEN VALLEY RD",
            "address_2": "SUITE 202",
            "city": "FREEDOM",
            "state": "CA",
            "postal_code": "950193160",
            "telephone_number": "831-728-2020",
            "fax_number": "831-728-4739"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DOUGLAS A LIDDICOAT INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-01",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "LIDDICOAT",
        "authorized_official_first_name": "DOUGLAS",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "831-728-2020",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "CA",
            "license": "C19432",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "OOC194320",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Ai-Huong DO, PHARM D
• Hai Phu Duong, PHARM D
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• Brandon Erickson, DDS
• Fastrackmed Urgent Care Inc

• Ophthalmology Physician in Freedom, CA
• Providers in Freedom, CA by specialty
• Ophthalmology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.