NPIMap

Organization Active NPI

Fourth Optometric Care of California

Doing business as Optometry in the Square

  • Optometrist
  • Lakewood, CA
National Provider Identifier
1932845559
Registry record updated Nov 1, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
Legal business name
FOURTH OPTOMETRIC CARE OF CALIFORNIA
Doing business as
Optometry in the Square
Practice address
4074 Hardwick St
Lakewood, CA 90712-2349
Phone
(562) 633-6443
NPI assigned
May 6, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 1, 2023

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

Authorized official

Name
Diana Holcomb
Title
Credentialing
Phone
(726) 444-4545

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193200000X MULTI-SPECIALTY GROUP 152W00000X Primary

Addresses

Primary practice location

4074 Hardwick St
Lakewood, CA 90712-2349

Mailing address

3333 Quality Dr
Rancho Cordova, CA 95670-7985
Phone (704) 712-0564

Other names 1

  • OPTOMETRY IN THE SQUARE Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20230315000196 CA Part B Supplier - Clinic/Group Practice 6305210345 Receives reassigned benefits from 48 practitioners
11 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Carlsbad, CA; Woodland Hills, CA; Westminster, CA; Torrance, CA; San Bruno, CA; Riverside, CA; Rancho Cordova, CA; Orange, CA…

Other NPIs on the same Medicare enrollment 11

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Fourth Optometric Care of California12 organizations share this tax ID, including this one

Other organizations with this tax ID 11

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

Locations

4074 Hardwick St
Lakewood, CA 90712
Phone (562) 633-6443

Practitioners & affiliated clinicians

Practitioners 2

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": "1651795200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1698796800000",
    "number": "1932845559",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3333 QUALITY DR",
            "city": "RANCHO CORDOVA",
            "state": "CA",
            "postal_code": "956707985",
            "telephone_number": "704-712-0564"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4074 HARDWICK ST",
            "city": "LAKEWOOD",
            "state": "CA",
            "postal_code": "907122349",
            "telephone_number": "562-633-6443"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FOURTH OPTOMETRIC CARE OF CALIFORNIA",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-05-06",
        "last_updated": "2023-11-01",
        "certification_date": "2023-11-01",
        "status": "A",
        "authorized_official_last_name": "HOLCOMB",
        "authorized_official_first_name": "DIANA",
        "authorized_official_title_or_position": "CREDENTIALING",
        "authorized_official_telephone_number": "726-444-4545"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "OPTOMETRY IN THE SQUARE",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lakewood, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 1, 2023; 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.