Active NPI
Randall Earl Conrad, O.D.
- Corneal and Contact Management Optometrist
- Poway, CA
National Provider Identifier
1962617464
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Corneal and Contact Management Optometrist
- License
- 6423T
- 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.
-
- Multi-Specialty Clinic/Center
- La Mesa, CA
- NPI 1619973591
-
- Optometrist
- San Diego, CA
- NPI 1356813711
-
- Optometrist
- Poway, CA
- NPI 1881969582
-
- Vision Therapy Optometrist
- El Cajon, CA
- NPI 1588790273
NPD (past) Corneal and Contact Management -
- Optometrist
- San Diego, CA
- NPI 1861529703
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
Medicare enrollment records 1
Medicare enrollment files| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20200928002376 | CA | Practitioner - Optometry | 6103120720 | Reassigns benefits to 2 organizations |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6423T | CA | MD | Corneal and Contact Management Optometrist |
| 6423 | CA | MD | Speech-Language Pathologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Alvarado Eye Associates Med Clinic Inc | Corneal and Contact Management | Current | Accepting new patients |
| Total Vision PC | Current | Accepting new patients | |
| Lisa M. Weiss, O.D. Optometric Corp | Corneal and Contact Management | Past | Accepting new patients |
| Donald J. Janiuk O.D. | Past | Accepting new patients | |
| Steven T Klein OD & Kimberly Plattner OD a Professional Corporation | Past | 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) | Code | License | State | Primary |
|---|---|---|---|---|
| Corneal and Contact Management Optometrist | 152WC0802X | 6423T | CA | Primary |
Addresses
NPPES NPI RegistryPrimary 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
- 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.