Petaluma Eye Care Optometric Associates, Inc. a Professional Corp.

Primary specialty

OptometristTaxonomy code 152W00000X

License

04916T Issued in CA

Legal business name

PETALUMA EYE CARE OPTOMETRIC ASSOCIATES, INC. A PROFESSIONAL CORP.

Practice address

129 Keller St
Petaluma, CA 94952-2934

Phone

(707) 763-2020

Fax

(707) 763-4735

NPI assigned

Jul 30, 2009

Organization subpart

No

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

Authorized official

Name

Ronald Lee Harris, O.D.NPI 1437159803

Title

Owner

Phone

(707) 763-2020

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Ronald Lee Harris, O.D.

  • Optometrist
  • Petaluma, CA
  • NPI 1437159803
  NPD (past) Authorized official

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

{
    "created_epoch": "1248912000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1392336000000",
    "number": "1851522411",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "129 KELLER ST",
            "city": "PETALUMA",
            "state": "CA",
            "postal_code": "949522934",
            "telephone_number": "707-763-2020",
            "fax_number": "707-763-4735"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "129 KELLER ST",
            "city": "PETALUMA",
            "state": "CA",
            "postal_code": "949522934",
            "telephone_number": "707-763-2020",
            "fax_number": "707-763-4735"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PETALUMA EYE CARE OPTOMETRIC ASSOCIATES, INC. A PROFESSIONAL CORP.",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-07-30",
        "last_updated": "2014-02-14",
        "status": "A",
        "authorized_official_last_name": "HARRIS",
        "authorized_official_first_name": "RONALD",
        "authorized_official_middle_name": "LEE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "707-763-2020",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": "CA",
            "license": "04916T",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9300440",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P01009218",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 14, 2014; 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.