Individual provider Active NPI

Joan Keddington, O.D.

  • Optometrist
  • National City, CA
National Provider Identifier
1992872691
Registry record updated Mar 23, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
6263T Issued in CA
Practice address
1481 E Plaza Blvd
National City, CA 91950-3613
Phone
(619) 477-2159
Fax
(619) 477-2128
NPI assigned
Nov 29, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 23, 2009

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 6263T CA Primary

Addresses

Primary practice location

1481 E Plaza Blvd
National City, CA 91950-3613

Mailing address

1773 Country Vistas LN
Bonita, CA 91902-3076
Phone (619) 421-8929

Other identifiers 1

IdentifierTypeStateIssuer
SD0062630MedicaidCA

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
I20060425000132 CA Practitioner - Optometry 0648217158 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
6263TCAMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Keddington & Kalra Optometrists Apc Optometrist CurrentSince Jan 1, 2006 Accepting new patients
Keddington & Kalra Optometrists Apc Optometrist CurrentSince Jan 1, 2006 Accepting new patients

Locations

1741 Eastlake Pkwy
Ste 101
Chula Vista, CA 91915
Phone (619) 421-6600

1481 E Plaza Blvd
National City, CA 91950
Phone (619) 477-2159

687 Sweetwater Rd
Spring Valley, CA 91977
Phone (619) 466-9444

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1164758400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1237766400000",
    "number": "1992872691",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1773 COUNTRY VISTAS LN",
            "city": "BONITA",
            "state": "CA",
            "postal_code": "919023076",
            "telephone_number": "619-421-8929",
            "fax_number": "619-271-6315"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1481 E PLAZA BLVD",
            "city": "NATIONAL CITY",
            "state": "CA",
            "postal_code": "919503613",
            "telephone_number": "619-477-2159",
            "fax_number": "619-477-2128"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KEDDINGTON",
        "first_name": "JOAN",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-29",
        "last_updated": "2009-03-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "6263T",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "SD0062630",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in National City, CA

Sources for this page

Verify at the official NPI Registry.