Individual provider Active NPI

Randall Earl Conrad, O.D.

  • Corneal and Contact Management Optometrist
  • Poway, CA
National Provider Identifier
1962617464
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Corneal and Contact Management OptometristTaxonomy code 152WC0802X
License
6423T Issued in CA
Practice address
12845 Poway Rd
Ste. 209
Poway, CA 92064-4529
Phone
(858) 748-6210
Fax
(858) 748-6224
NPI assigned
May 10, 2007
Sex
Male
Sole proprietor
No

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

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: No
  • Hospice: Yes
Green means eligible to order or refer.

Medicare enrollment records 1

Medicare enrollment files
Enrollment IDStateProvider typePAC IDDetails
I20200928002376 CA Practitioner - Optometry 6103120720 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
6423TCAMDCorneal and Contact Management Optometrist
6423CAMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
Alvarado Eye Associates Med Clinic Inc Corneal and Contact Management CurrentSince Dec 20, 2023 Accepting new patients
Total Vision PC CurrentSince Jun 23, 2020 Accepting new patients
Lisa M. Weiss, O.D. Optometric Corp Corneal and Contact Management PastSince Mar 1, 2007 Accepting new patients
Donald J. Janiuk O.D. Past Accepting new patients
Steven T Klein OD & Kimberly Plattner OD a Professional Corporation PastSince Jun 23, 2020 Accepting new patients

Locations

801 Orange Ave
Ste 204
Coronado, CA 92118
Phone (614) 460-3711

303 E Main St
El Cajon, CA 92020
Phone (619) 444-1153

7877 Parkway Dr
Ste 100
La Mesa, CA 91942
Phone (619) 460-3711

27271 Las Ramblas
Ste 210
Mission Viejo, CA 92691

11717 Bernardo Plaza Ct
Ste 105
San Diego, CA 92128
Phone (858) 487-5555

Specialties & licenses 1

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
Corneal and Contact Management Optometrist 152WC0802X 6423T CA Primary

Addresses

NPPES NPI Registry

Primary practice location

12845 Poway Rd
Ste. 209
Poway, CA 92064-4529

Mailing address

472 Nila
Poway, CA 92020
Phone (619) 444-7269

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jul 8, 2007.

{
    "created_epoch": "1178755200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1962617464",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "472 NILA",
            "city": "POWAY",
            "state": "CA",
            "postal_code": "92020",
            "telephone_number": "619-444-7269",
            "fax_number": "858-748-6224"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12845 POWAY RD",
            "address_2": "STE. 209",
            "city": "POWAY",
            "state": "CA",
            "postal_code": "920644529",
            "telephone_number": "858-748-6210",
            "fax_number": "858-748-6224"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CONRAD",
        "first_name": "RANDALL",
        "middle_name": "EARL",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-05-10",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152WC0802X",
            "taxonomy_group": "",
            "desc": "Optometrist, Corneal and Contact Management",
            "state": "CA",
            "license": "6423T",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Poway, CA

Sources for this page

Verify at the official NPI Registry.