Brookside Optometric Group

Primary specialty

OptometristTaxonomy code 152W00000X

Legal business name

BROOKSIDE OPTOMETRIC GROUP

Practice address

3133 W March LN Ste 2020
Stockton, CA 95219-2361

Phone

(209) 951-0820

NPI assigned

Mar 28, 2007

Last updated

Aug 6, 2013By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Craig Hisaka, O.D.

Title

Owner

Phone

(209) 951-0820

Specialties & licenses 1

Addresses

Other identifiers 3

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Rosemary Melrose, O.D.

  • Optometrist
  • Stockton, CA
  • NPI 1366556870
  NPD
• Richard Vanover, O.D.

  • Optometrist
  • Stockton, CA
  • NPI 1528022035
  NPD

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

{
    "created_epoch": "1175040000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1375747200000",
    "number": "1922127356",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3133 W MARCH LN STE 2020",
            "city": "STOCKTON",
            "state": "CA",
            "postal_code": "952192361"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3133 W MARCH LN STE 2020",
            "city": "STOCKTON",
            "state": "CA",
            "postal_code": "952192361",
            "telephone_number": "209-951-0820"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BROOKSIDE OPTOMETRIC GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-28",
        "last_updated": "2013-08-06",
        "status": "A",
        "authorized_official_last_name": "HISAKA",
        "authorized_official_first_name": "CRAIG",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "209-951-0820",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "SD0107720",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "SD0059260",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "SD0094740",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Thomas David Brokaw, MD
• Peyton Louise Brooker
• Glynis Brooks, CAADE
• Susan E. Brookshire
• Brookside Care Center LLC (Brookside Care Center)
• Jeffery T Brotherton, HIS
• Detranay Brown Buntun
• Aaliyah Norma Renee Brown
• Alexandra Leigh Brown
• Alexandria Roberta Brown

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 6, 2013; 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.