Individual provider Active NPI

Bryan Doherty, O.D.

  • Optometrist
  • Concord, CA
National Provider Identifier
1972645943
Registry record updated Feb 22, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
11126T Issued in CA
Practice address
5100 Clayton Rd
Ste D30
Concord, CA 94521-3104
Phone
(925) 825-1090
Fax
(925) 825-1095
NPI assigned
Feb 13, 2007
Last updated
Feb 22, 2016By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 22, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 11126T CA Primary

Addresses

Primary practice location

5100 Clayton Rd
Ste D30
Concord, CA 94521-3104

Mailing address

5100 Clayton Rd
Ste D30
Concord, CA 94521-3104

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.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070507000667 CA Practitioner - Optometry 5698871614 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
University of California - School of Optometry, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Gee and Doherty Optometry PCGroup PAC ID 1951499912, 2 clinicians

Practice addresses (Care Compare)

5100 Clayton Rd
Suite D30
Concord, CA 94521-3104
Phone (925) 825-1090

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
11126TCAMDOptometrist
11126CAMDPhysical Therapy Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Insight Vision Care Optometry Optometrist CurrentSince Dec 31, 2021 Accepting new patients
Michael a. Roy, O.D. Inc. CurrentSince Dec 31, 2021 Accepting new patients

Locations

675 Ygnacio Valley Rd
Ste B103
Walnut Creek, CA 94596
Phone (925) 933-0270

Organizations & group practices 3

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

NPI Registry JSON

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

{
    "created_epoch": "1171324800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1456099200000",
    "number": "1972645943",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5100 CLAYTON RD",
            "address_2": "STE D30",
            "city": "CONCORD",
            "state": "CA",
            "postal_code": "945213104"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5100 CLAYTON RD",
            "address_2": "STE D30",
            "city": "CONCORD",
            "state": "CA",
            "postal_code": "945213104",
            "telephone_number": "925-825-1090",
            "fax_number": "925-825-1095"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DOHERTY",
        "first_name": "BRYAN",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-02-13",
        "last_updated": "2016-02-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "11126T",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Concord, CA

Sources for this page

Verify at the official NPI Registry.