Woodcrest Vision Center- Optometry

Primary specialty

OptometristTaxonomy code 152W00000X

License

OPT 6553T Issued in CA

Legal business name

WOODCREST VISION CENTER- OPTOMETRY

Practice address

17675 Van Buren Blvd
Suite C
Riverside, CA 92504

Phone

(951) 780-0270

Fax

(951) 780-4807

NPI assigned

May 15, 2007

Organization subpart

No

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

Authorized official

Name

Peter Shaw MC Minn, O.D.

Title

Owner Optometrist

Phone

(951) 780-0270

Specialties & licenses 1

Addresses

Other identifiers 1

Tax ID family

Woodcrest Vision Center2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Woodcrest Vision Center

  • Optometrist
  • Riverside, CA
  • NPI 1912184359
  NPD tax ID

Locations

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

{
    "created_epoch": "1179187200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1214784000000",
    "number": "1891901294",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17675 VAN BUREN BLVD",
            "address_2": "SUITE C",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "92504",
            "telephone_number": "951-780-0270",
            "fax_number": "951-780-4807"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17675 VAN BUREN BLVD",
            "address_2": "SUITE C",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "92504",
            "telephone_number": "951-780-0270",
            "fax_number": "951-780-4807"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WOODCREST VISION CENTER- OPTOMETRY",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-15",
        "last_updated": "2008-06-30",
        "status": "A",
        "authorized_official_last_name": "SHAW MC MINN",
        "authorized_official_first_name": "PETER",
        "authorized_official_title_or_position": "OWNER OPTOMETRIST",
        "authorized_official_telephone_number": "951-780-0270",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "CA",
            "license": "OPT 6553T",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "ZZZ95800Z",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Lora Ann Wood
• Samantha Michelle Wood, MSN, CRNA
• Ashley Lauren Woodcock, NP-C
• Woodcrest Medical Center, Inc.
• Woodcrest Vision Center
• Ernest Woodhouse, M.D.
• David J. Wooding, MD
• Natalie Janelly Woodruff, PA-C
• Deja Woods-Vargas
• Bernadette Woods

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2008; 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.