Tedder Optometric Clinic Management, P.C.

Primary specialty

OptometristTaxonomy code 152W00000X

Legal business name

TEDDER OPTOMETRIC CLINIC MANAGEMENT, P.C.

Practice address

17064 Slover Ave Ste 104
Fontana, CA 92337-7592

Phone

(909) 258-4620

NPI assigned

Mar 8, 2023

Last updated

Aug 25, 2025By 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

Dr. Taylor Dean Tedder, ODNPI 1639364532

Title

President

Phone

(805) 624-1255

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Locations

Practitioners 13

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.

• Khanh Yen Dang, OD

  • Optometrist
  • Redlands, CA
  • NPI 1346083755
  Medicare reassignment Care Compare group NPD
• Taylor D Tedder, O.D.

  • Optometrist
  • Moorpark, CA
  • NPI 1639364532
  Medicare reassignment NPD Authorized official
• Emmy Thai, OD

  • Optometrist
  • Fontana, CA
  • NPI 1558953661
  Medicare reassignment Care Compare group NPD
• Mai-Anh Bui, O.D.

  • Optometrist
  • Torrance, CA
  • NPI 1396999603
  Medicare reassignment NPD
• Laura Leticia Garnica, OD

  • Optometrist
  • Colton, CA
  • NPI 1598348468
  Medicare reassignment NPD
• Phoebe Hoang, OD

  • Optometrist
  • Culver City, CA
  • NPI 1558154104
  Medicare reassignment NPD
• Mousami Paver, O.D.

  • Optometrist
  • Irvine, CA
  • NPI 1154514495
  Medicare reassignment NPD
• Antoinette Lam Vu, OD

  • Optometrist
  • Fontana, CA
  • NPI 1720602345
  Medicare reassignment NPD
• Kyrillos Zaki, OD

  • Optometrist
  • Redlands, CA
  • NPI 1215718804
  Medicare reassignment NPD
• Michael Vathanasaynee, O.D.

  • Optometrist
  • N Las Vegas, NV
  • NPI 1083810212

  CA

  Medicare reassignment NPD
• Catherine Lam, OD

  • Optometrist
  • Culver City, CA
  • NPI 1467123521
  NPD (past)
• Jeanie Tran, OD

  • Optometrist
  • Santa Clarita, CA
  • NPI 1043857832
  NPD (past)

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

{
    "created_epoch": "1678233600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1756080000000",
    "number": "1851091805",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "530 NEW LOS ANGELES AVE STE 115-269",
            "city": "MOORPARK",
            "state": "CA",
            "postal_code": "930212081",
            "telephone_number": "805-624-1255"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17064 SLOVER AVE STE 104",
            "city": "FONTANA",
            "state": "CA",
            "postal_code": "923377592",
            "telephone_number": "909-258-4620"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "530 New Los Angeles Ave Ste 115-269",
            "address_purpose": "LOCATION",
            "city": "Moorpark",
            "state": "CA",
            "postal_code": "930212081",
            "country_code": "US",
            "telephone_number": "805-624-1255",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "15268 Summit Ave",
            "address_purpose": "LOCATION",
            "city": "Fontana",
            "state": "CA",
            "postal_code": "923360234",
            "country_code": "US",
            "telephone_number": "805-624-1255",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "TEDDER OPTOMETRIC CLINIC MANAGEMENT, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-03-08",
        "last_updated": "2025-08-25",
        "certification_date": "2025-08-25",
        "status": "A",
        "authorized_official_last_name": "TEDDER",
        "authorized_official_first_name": "TAYLOR",
        "authorized_official_middle_name": "DEAN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "805-624-1255",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Zackary Willis Taylor
• Majid Tayyarah, MD
• Jessica Lozano Tea
• Brittney Branae Teague
• Victoria Shar Tecson, D.O.
• Teg Medical Transport
• Samir G. Tejwani, MD
• Charnnai Antionette Tekle, RN, ADN
• Telecare Copration (Merrill Center)
• Telecare Corporation (Wellspring Center)

• Optometrist in Fontana, CA
• Providers in Fontana, CA by specialty
• Optometrist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 25, 2025; 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.