NPIMap

Organization Active NPI

Menifee Valley Optometry PC

  • Optometrist
  • Menifee, CA
National Provider Identifier
1881945038
Registry record updated Oct 27, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
OPT8225TLG Issued in CA
Legal business name
MENIFEE VALLEY OPTOMETRY PC
Practice address
27168 Newport Rd
Suite 4
Menifee, CA 92584-7383
Phone
(951) 679-0545
Fax
(951) 679-6154
NPI assigned
Sep 27, 2012
Last updated
Oct 27, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 27, 2016

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

Authorized official

Name
Dr. Eric M. Fennema, O.D.NPI 1710048939
Title
Owner
Phone
(951) 679-0545

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X OPT8225TLG CA Primary

Addresses

Primary practice location

27168 Newport Rd
Suite 4
Menifee, CA 92584-7383

Mailing address

27168 Newport Rd.
Suite 4
Menifee, CA 92584-6526
Phone (951) 679-0545

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 7

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.

NPI Registry JSON

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

{
    "created_epoch": "1348704000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1477526400000",
    "number": "1881945038",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "27168 NEWPORT RD.",
            "address_2": "SUITE 4",
            "city": "MENIFEE",
            "state": "CA",
            "postal_code": "925846526",
            "telephone_number": "951-679-0545",
            "fax_number": "951-679-6154"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "27168 NEWPORT RD",
            "address_2": "SUITE 4",
            "city": "MENIFEE",
            "state": "CA",
            "postal_code": "925847383",
            "telephone_number": "951-679-0545",
            "fax_number": "951-679-6154"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MENIFEE VALLEY OPTOMETRY PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-09-27",
        "last_updated": "2016-10-27",
        "status": "A",
        "authorized_official_last_name": "FENNEMA",
        "authorized_official_first_name": "ERIC",
        "authorized_official_middle_name": "M.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "951-679-0545",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "OPT8225TLG",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Menifee, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 27, 2016; 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.