NPIMap

Organization Active NPI

Kenneth V. Miselis, M.D. Inc.

Doing business as Heritage Eye Associates

  • Specialist
  • Stockton, CA
National Provider Identifier
1962413740
Registry record updated Jun 17, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
G502810 Issued in CA
Legal business name
KENNETH V. MISELIS, M.D. INC.
Doing business as
Heritage Eye Associates
Practice address
445 W Poplar St
Stockton, CA 95203-2426
Phone
(209) 465-5933
Fax
(209) 465-2562
NPI assigned
Aug 10, 2006
Last updated
Jun 17, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 17, 2020

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

Authorized official

Name
Dr. Kenneth Victor Miselis, M.D.NPI 1730154592
Title
President
Phone
(209) 465-5933

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193200000X MULTI-SPECIALTY GROUP 174400000X G502810 CA Primary

Addresses

Primary practice location

445 W Poplar St
Stockton, CA 95203-2426

Mailing address

445 W Poplar St
Stockton, CA 95203-2426
Phone (209) 465-5933

Other names 1

  • HERITAGE EYE ASSOCIATES Doing business as

National Provider Directory

National Provider Directory

Locations

801 E Mountain View St
#1
Barstow, CA 92311

445 W Poplar St
Stockton, CA 95203
Phone (209) 465-5933

12370 Hesperia Rd
Ste 13
Victorville, CA 92395
Phone (760) 245-4747

12408 Hesperia Rd
Ste 21
Victorville, CA 92395
Phone (760) 245-4747

12408 Hesperia Rd
Ste 28
Victorville, CA 92395
Phone (760) 261-6422

Practitioners & affiliated clinicians

Practitioners 48

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.

View all 48

NPI Registry JSON

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

{
    "created_epoch": "1155168000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1592352000000",
    "number": "1962413740",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "445 W POPLAR ST",
            "city": "STOCKTON",
            "state": "CA",
            "postal_code": "952032426",
            "telephone_number": "209-465-5933",
            "fax_number": "209-465-2562"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "445 W POPLAR ST",
            "city": "STOCKTON",
            "state": "CA",
            "postal_code": "952032426",
            "telephone_number": "209-465-5933",
            "fax_number": "209-465-2562"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KENNETH V. MISELIS, M.D. INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-10",
        "last_updated": "2020-06-17",
        "certification_date": "2020-06-17",
        "status": "A",
        "authorized_official_last_name": "MISELIS",
        "authorized_official_first_name": "KENNETH",
        "authorized_official_middle_name": "VICTOR",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "209-465-5933",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist",
            "state": "CA",
            "license": "G502810",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "HERITAGE EYE ASSOCIATES",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Stockton, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 2020; 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.