Modesto Optometric Vision Center Inc a Professional Optometric Corp

Primary specialty

OptometristTaxonomy code 152W00000X

Legal business name

MODESTO OPTOMETRIC VISION CENTER INC A PROFESSIONAL OPTOMETRIC CORP

Practice address

3601 Coffee Rd
Modesto, CA 95355-1161

Phone

(209) 521-1028

Fax

(209) 521-7488

NPI assigned

Sep 1, 2022

Last updated

Mar 24, 2023By 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

Lori Anderson

Title

Office Manager

Phone

(209) 869-3300

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Practitioners 6

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.

• Brian Edward Elliott, O.D.

  • Optometrist
  • Riverbank, CA
  • NPI 1760566434
  Medicare reassignment NPD
• Garrett William Elliott, OD

  • Optometrist
  • Modesto, CA
  • NPI 1427710706
  NPD
• Neelam Thiara, DOCTOR OF OPTOMETRY

  • Optometrist
  • Tracy, CA
  • NPI 1477108421
  NPD
• Cecilia Sze Ka Tong, O.D.

  • Optometrist
  • Modesto, CA
  • NPI 1598107195
  NPD
• L. Edward Elliott, O.D.

  • Corneal and Contact Management Optometrist
  • Escalon, CA
  • NPI 1023000502
  NPD (past)
• Laurena Carole Krieger, OD

  • Optometrist
  • Escalon, CA
  • NPI 1659438802
  NPD (past)

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

{
    "created_epoch": "1661990400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1679616000000",
    "number": "1891415410",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3601 COFFEE RD",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953551161",
            "telephone_number": "209-521-1028",
            "fax_number": "209-521-7488"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3601 COFFEE RD",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953551161",
            "telephone_number": "209-521-1028",
            "fax_number": "209-521-7488"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MODESTO OPTOMETRIC VISION CENTER INC A PROFESSIONAL OPTOMETRIC CORP",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-09-01",
        "last_updated": "2023-03-24",
        "certification_date": "2023-03-24",
        "status": "A",
        "authorized_official_last_name": "ANDERSON",
        "authorized_official_first_name": "LORI",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "209-869-3300"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Modesto Pain Diagnostic Treatment Center
• Modesto Pediatrics
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• Optometrist in Modesto, CA
• Providers in Modesto, CA by specialty
• Optometrist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 24, 2023; 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.