Active NPI
Mervyn R Stein, MD
- Ophthalmology Physician
- San Rafael, CA
National Provider Identifier
1902932734
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Ophthalmology Physician
- License
- 00G164240
- Practice address
- 950 Northgate Dr
Suite 209
San Rafael, CA 94903-3433 - Phone
- (415) 479-2372
- Fax
- (415) 472-6225
- NPI assigned
- Feb 26, 2007
- Sex
- Male
- Sole proprietor
- No
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 | 00G164240 | CA | Primary |
Addresses
Primary practice location
950 Northgate Dr
Suite 209
San Rafael, CA 94903-3433
Mailing address
950 Northgate Dr
Suite 209
San Rafael, CA 94903-3433
Phone (415) 479-2372
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00G164240 | 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)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 00G164240 | CA | MD | Ophthalmology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1172448000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1902932734",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "950 NORTHGATE DR",
"address_2": "SUITE 209",
"city": "SAN RAFAEL",
"state": "CA",
"postal_code": "949033433",
"telephone_number": "415-479-2372",
"fax_number": "415-472-6225"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "950 NORTHGATE DR",
"address_2": "SUITE 209",
"city": "SAN RAFAEL",
"state": "CA",
"postal_code": "949033433",
"telephone_number": "415-479-2372",
"fax_number": "415-472-6225"
}
],
"practiceLocations": [],
"basic": {
"last_name": "STEIN",
"first_name": "MERVYN",
"middle_name": "R",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-02-26",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "207W00000X",
"taxonomy_group": "",
"desc": "Ophthalmology",
"state": "CA",
"license": "00G164240",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00G164240",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in San Rafael, 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.