Heritage Eye Associates

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

License

G502810 Issued in CA

Legal business name

HERITAGE EYE ASSOCIATES

Practice address

5762 E Acorn CT
Stockton, CA 95212-2622

Phone

(209) 465-2581

NPI assigned

Mar 14, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Kenneth V Miselis, M.D.NPI 1730154592

Title

President

Phone

(209) 465-5562

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Kenneth Victor Miselis, M.D.

  • Specialist
  • Stockton, CA
  • NPI 1730154592
  NPD (past) Authorized official

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

{
    "created_epoch": "1173830400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1731974400000",
    "number": "1972636397",
    "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": "209-465-2568"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5762 E ACORN CT",
            "city": "STOCKTON",
            "state": "CA",
            "postal_code": "952122622",
            "telephone_number": "209-465-2581"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HERITAGE EYE ASSOCIATES",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-14",
        "last_updated": "2024-11-19",
        "certification_date": "2024-11-19",
        "status": "A",
        "authorized_official_last_name": "MISELIS",
        "authorized_official_first_name": "KENNETH",
        "authorized_official_middle_name": "V",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "209-465-5562",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "CA",
            "license": "G502810",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE DMERC",
            "identifier": "076183001",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kyle Wayne Herbold, M.D.
• Anamaria Heredia
• Lilyana Heredia
• Wendy Hereria
• Heritage Estates, Inc.
• Rossie Xiomara Hermosillo Castaneda
• Jessica Hernadez
• Gabriela Hernandez Banuelos
• Estefania Hernandez Luna
• Gricelda Y Hernandez Mendoza

• Durable Medical Equipment & Medical Supplies in Stockton, CA
• Providers in Stockton, CA by specialty
• Durable Medical Equipment & Medical Supplies in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 19, 2024; 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.