Enterprise Optometry Group Inc.
Organization Active NPI Optometrist · Redding, CA
NPI 1962052365 · NPPES record last updated Oct 15, 2020
Key facts
- NPI
- 1962052365
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Optometrist 152W00000X
- Legal business name
- ENTERPRISE OPTOMETRY GROUP INC.
- Practice address
- 3080 Victor Ave
Redding, CA 96002-1449 - Phone
- (530) 222-3166
- Fax
- (530) 222-6539
- NPI assigned
- Sep 17, 2019
- Organization subpart
- No
Authorized official
- Name
- Amanda Callaway
- Title
- Billing Manager
- Phone
- (530) 222-3166
Practitioners 6
-
Gary Gallagher, O.D.
-
Diana Isabel Iraheta, O.D
-
Mitchell L. Martin, O.D.
-
Theresa T Asato, O.D.
-
Stacy Catherine Cullum, O.D.
-
Richard Arthur Martin, O.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in CA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20200110001880 | CA | DME Supplier - Physician - Optometrist | 9234564782 | Practice locations: Redding, CA |
| O20200522000347 | CA | Part B Supplier - Clinic/Group Practice | 9234564782 |
Receives reassigned benefits from 3 practitioners Practice locations: Redding, CA |
National Provider Directory
Locations
3080 Victor Ave
Redding, CA 96002
Phone (530) 222-3166
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist |
152W00000X | Yes |
Addresses
Primary practice location
3080 Victor Ave
Redding, CA 96002-1449
Mailing address
3080 Victor Ave
Redding, CA 96002-1449
Phone (530) 222-3166
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 7781880001 | Other | CA | DMERC PTAN |
| CA408836 | Other | CA | MEDICARE PTAN |
Other providers in Redding, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 15, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.