Active NPI
Judith Prima, O.D.
- Optometrist
- Stockton, CA
National Provider Identifier
1861456238
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 5926T
- Practice address
- 3133 W March LN
Suite 2020
Stockton, CA 95219-2336 - Phone
- (209) 951-0820
- Fax
- (209) 951-2348
- NPI assigned
- Apr 13, 2006
- Last updated
- Feb 13, 2013
- Sex
- Female
- 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 | 5926T | CA | Primary |
Addresses
Primary practice location
3133 W March LN
Suite 2020
Stockton, CA 95219-2336
Mailing address
3133 W March LN
Suite 2020
Stockton, CA 95219-2336
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| SD0059260 | Medicaid | CA | |
| 0694800001 | Other | CA | DMERC |
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 |
|---|---|---|---|
| 5926T | CA | MD | Optometrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Peter V. Hetzner, O.D. | Optometrist | Past | Accepting new patients |
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": "1144886400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1360713600000",
"number": "1861456238",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3133 W MARCH LN",
"address_2": "SUITE 2020",
"city": "STOCKTON",
"state": "CA",
"postal_code": "952192336"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3133 W MARCH LN",
"address_2": "SUITE 2020",
"city": "STOCKTON",
"state": "CA",
"postal_code": "952192336",
"telephone_number": "209-951-0820",
"fax_number": "209-951-2348"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PRIMA",
"first_name": "JUDITH",
"credential": "O.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-04-13",
"last_updated": "2013-02-13",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "CA",
"license": "5926T",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "SD0059260",
"state": "CA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DMERC",
"identifier": "0694800001",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Stockton, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 13, 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.