Active NPI
Kerry Scot Anderson, O.D.
- Optometrist
- Chino, CA
National Provider Identifier
1851404628
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- OPT 9775 TPA
- Practice address
- 14335 Pipeline Ave
Chino, CA 91710-5642 - Phone
- (909) 628-8860
- Fax
- (909) 628-6120
- NPI assigned
- Aug 16, 2006
- Last updated
- Dec 28, 2012
- 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 | OPT 9775 TPA | CA | Primary |
Addresses
Primary practice location
14335 Pipeline Ave
Chino, CA 91710-5642
Mailing address
21078 Jewel CT
Diamond Bar, CA 91765-4038
Phone (909) 628-8860
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| SD0097750 | Medicaid | CA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| OPT 9775 TPA | CA | MD | Optometrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Primigenia Optometry Inc | Optometrist | Current | Accepting new patients |
Locations
14461 Merced Ave
Ste 101
Baldwin Park, CA 91706
Phone (626) 939-4588
14335 Pipeline Ave
Ste A5
Chino, CA 91710
Phone (909) 628-8860
Networks
- BSC 65 PLUS INDIVIDUAL MAPD
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1155686400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1356652800000",
"number": "1851404628",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "21078 JEWEL CT",
"city": "DIAMOND BAR",
"state": "CA",
"postal_code": "917654038",
"telephone_number": "909-628-8860",
"fax_number": "909-628-6120"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "14335 PIPELINE AVE",
"city": "CHINO",
"state": "CA",
"postal_code": "917105642",
"telephone_number": "909-628-8860",
"fax_number": "909-628-6120"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ANDERSON",
"first_name": "KERRY",
"middle_name": "SCOT",
"name_prefix": "Dr.",
"credential": "O.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-08-16",
"last_updated": "2012-12-28",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "CA",
"license": "OPT 9775 TPA",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "SD0097750",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Chino, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 28, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.