Active NPI
Robert S Herrick, M.D.
- Ophthalmology Physician
- Rialto, CA
National Provider Identifier
1902809817
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Ophthalmology Physician
- License
- C24395
- Practice address
- 882 W Rialto Ave
Rialto, CA 92376-5658 - Phone
- (909) 820-4051
- Fax
- (909) 820-4053
- NPI assigned
- May 24, 2005
- Reactivated
- Mar 24, 2006
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Ophthalmology Physician | 207W00000X | C24395 | CA | Primary |
Addresses
Primary practice location
882 W Rialto Ave
Rialto, CA 92376-5658
Mailing address
882 W Rialto Ave
Rialto, CA 92376-5658
Phone (909) 820-4051
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00C243950 | Medicaid | CA |
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
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| C24395 | CA | MD | Ophthalmology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1116892800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1902809817",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "882 W RIALTO AVE",
"city": "RIALTO",
"state": "CA",
"postal_code": "923765658",
"telephone_number": "909-820-4051",
"fax_number": "909-820-4053"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "882 W RIALTO AVE",
"city": "RIALTO",
"state": "CA",
"postal_code": "923765658",
"telephone_number": "909-820-4051",
"fax_number": "909-820-4053"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HERRICK",
"first_name": "ROBERT",
"middle_name": "S",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2005-05-24",
"last_updated": "2007-07-08",
"deactivation_date": "2006-03-16",
"reactivation_date": "2006-03-24",
"status": "A"
},
"taxonomies": [
{
"code": "207W00000X",
"taxonomy_group": "",
"desc": "Ophthalmology",
"state": "CA",
"license": "C24395",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00C243950",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Rialto, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.