Active NPI
Christopher John Dickens, M.D.
- Ophthalmology Physician
- Oakland, CA
National Provider Identifier
1962560326
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Ophthalmology Physician
- License
- G52201
- Practice address
- 491 30TH St
Suite 103
Oakland, CA 94609-3235 - Phone
- (510) 763-9775
- Fax
- (510) 763-1501
- NPI assigned
- Dec 5, 2006
- Sex
- Male
- Sole proprietor
- Yes
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 | G52201 | CA | Primary |
Addresses
Primary practice location
491 30TH St
Suite 103
Oakland, CA 94609-3235
Mailing address
491 30TH St
Suite 103
Oakland, CA 94609-3235
Phone (510) 763-9775
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00G522010 | Medicaid | CA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20050613000529 | CA | Practitioner - Ophthalmology | 9537103478 | Practice locations: Oakland, CA |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| G52201 | CA | MD | Ophthalmology Physician |
| 52201 | CA | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1165276800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1962560326",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "491 30TH ST",
"address_2": "SUITE 103",
"city": "OAKLAND",
"state": "CA",
"postal_code": "946093235",
"telephone_number": "510-763-9775",
"fax_number": "510-763-1501"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "491 30TH ST",
"address_2": "SUITE 103",
"city": "OAKLAND",
"state": "CA",
"postal_code": "946093235",
"telephone_number": "510-763-9775",
"fax_number": "510-763-1501"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DICKENS",
"first_name": "CHRISTOPHER",
"middle_name": "JOHN",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-12-05",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "207W00000X",
"taxonomy_group": "",
"desc": "Ophthalmology",
"state": "CA",
"license": "G52201",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00G522010",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Oakland, 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.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.