Organization Active NPI

Dr. Wayne Ogata O.D. Inc.

  • Optometrist
  • Vallejo, CA
National Provider Identifier
1902840796
Registry record updated Aug 6, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
9705T Issued in CA
Legal business name
DR. WAYNE OGATA O.D. INC.
Practice address
4300 Sonoma Blvd
#508
Vallejo, CA 94589-2200
Phone
(707) 643-8891
Fax
(707) 644-8649
NPI assigned
Jun 15, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 6, 2010

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

Authorized official

Name
Dr. Wayne Kaneo Ogata, O.D.NPI 1538100953
Title
President
Phone
(707) 643-8891

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X 9705T CA Primary

Addresses

Primary practice location

4300 Sonoma Blvd
#508
Vallejo, CA 94589-2200

Mailing address

4300 Sonoma Blvd
#508
Vallejo, CA 94589-2200
Phone (707) 643-8891

Other identifiers 1

IdentifierTypeStateIssuer
9705TOtherCALICENSE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100210000645 CA Part B Supplier - Clinic/Group Practice 0042211617 Receives reassigned benefits from 1 practitioner
Practice locations: Clearlake, CA; Vallejo, CA

National Provider Directory

National Provider Directory

Locations

4456 Manzanita Ave
Ste C
Clearlake, CA 95422
Phone (707) 994-0707

4300 Sonoma Blvd
Ste 508
Vallejo, CA 94589
Phone (707) 643-8891

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1150329600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1281052800000",
    "number": "1902840796",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4300 SONOMA BLVD",
            "address_2": "#508",
            "city": "VALLEJO",
            "state": "CA",
            "postal_code": "945892200",
            "telephone_number": "707-643-8891",
            "fax_number": "707-644-8649"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4300 SONOMA BLVD",
            "address_2": "#508",
            "city": "VALLEJO",
            "state": "CA",
            "postal_code": "945892200",
            "telephone_number": "707-643-8891",
            "fax_number": "707-644-8649"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DR. WAYNE OGATA O.D. INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-15",
        "last_updated": "2010-08-06",
        "status": "A",
        "authorized_official_last_name": "OGATA",
        "authorized_official_first_name": "WAYNE",
        "authorized_official_middle_name": "KANEO",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "707-643-8891",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "CA",
            "license": "9705T",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "9705T",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Vallejo, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 6, 2010; 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.