Active NPI
Stephen C Puckett, O.D.
- Optometrist
- Vallejo, CA
National Provider Identifier
1972536308
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 10914T
- Practice address
- 127 Hospital Dr
Suite 201
Vallejo, CA 94589-2500 - Phone
- (707) 554-3101
- Fax
- (707) 554-2402
- NPI assigned
- Jul 9, 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 |
|---|---|---|---|---|
| Optometrist | 152W00000X | 10914T | CA | Primary |
Addresses
Primary practice location
127 Hospital Dr
Suite 201
Vallejo, CA 94589-2500
Mailing address
3042 Santa Maria CT
Concord, CA 94518-2812
Phone (925) 682-1959
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 10914T | CA | MD | Optometrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Patricia Ebright, O.D., Inc | Optometrist | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Optometrist
- Vallejo, CA
- NPI 1649317207
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1152403200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1194998400000",
"number": "1972536308",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3042 SANTA MARIA CT",
"city": "CONCORD",
"state": "CA",
"postal_code": "945182812",
"telephone_number": "925-682-1959"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "127 HOSPITAL DR",
"address_2": "SUITE 201",
"city": "VALLEJO",
"state": "CA",
"postal_code": "945892500",
"telephone_number": "707-554-3101",
"fax_number": "707-554-2402"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PUCKETT",
"first_name": "STEPHEN",
"middle_name": "C",
"name_prefix": "Dr.",
"credential": "O.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-07-09",
"last_updated": "2007-11-14",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "CA",
"license": "10914T",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Vallejo, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 14, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.