Active NPI
Gary Martin Fishberg, O.D.
- Corneal and Contact Management Optometrist
- Riverside, CA
National Provider Identifier
1891837852
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Corneal and Contact Management Optometrist
- License
- 6656T
- Practice address
- 5225 Canyon Crest Dr Ste 201
Riverside, CA 92507-6323 - Phone
- (951) 788-2020
- Fax
- (951) 684-2020
- NPI assigned
- Feb 13, 2007
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 6656 | CA | |
| Corneal and Contact Management Optometrist | 152WC0802X | 6656T | CA | Primary |
Addresses
Primary practice location
5225 Canyon Crest Dr Ste 201
Riverside, CA 92507-6323
Mailing address
5225 Canyon Crest Dr Ste 201
Riverside, CA 92507-6323
Phone (951) 788-2020
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| SD0066562 | Medicaid | CA |
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | fish1110@verizon.net |
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 |
|---|---|---|---|
| 6656T | CA | MD | Corneal and Contact Management Optometrist |
| 6656 | CA | MD | Feeding, Eating & Swallowing Occupational Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1171324800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1581465600000",
"number": "1891837852",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5225 CANYON CREST DR STE 201",
"city": "RIVERSIDE",
"state": "CA",
"postal_code": "925076323",
"telephone_number": "951-788-2020",
"fax_number": "951-684-2020"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5225 CANYON CREST DR STE 201",
"city": "RIVERSIDE",
"state": "CA",
"postal_code": "925076323",
"telephone_number": "951-788-2020",
"fax_number": "951-684-2020"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FISHBERG",
"first_name": "GARY",
"middle_name": "MARTIN",
"name_prefix": "Dr.",
"credential": "O.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-02-13",
"last_updated": "2020-02-12",
"certification_date": "2020-02-12",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "CA",
"license": "6656",
"primary": false
},
{
"code": "152WC0802X",
"taxonomy_group": "",
"desc": "Optometrist, Corneal and Contact Management",
"state": "CA",
"license": "6656T",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "SD0066562",
"state": "CA"
}
],
"endpoints": [
{
"endpointType": "CONNECT",
"endpointTypeDescription": "CONNECT URL",
"endpoint": "fish1110@verizon.net",
"affiliation": "N",
"address_1": "12413 Norwalk Blvd",
"city": "Norwalk",
"state": "CA",
"country_code": "US",
"postal_code": "906502040",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Riverside, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 12, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.