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  7. NPI Record 1316468176

OPTOMETRIC CENTER AND EYEWEAR GALLERIA
Complete NPI Record 1316468176
Optometrist in San Ramon, CA

NPI Status: Active since July 03, 2017

Contact Information

2551 SAN RAMON VALLEY BLVD STE 101
SAN RAMON, CA
ZIP 94583
Phone: (925) 743-1222
Fax: (925) 743-1221

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Table of Contents

  1. NPI
  2. Entity Type Code
  3. Employer Identification Number EIN
  4. Provider Organization Name Legal Business Name
  5. Provider Other Organization Name
  6. Provider Other Organization Name Type Code
  7. Provider First Line Business Mailing Address
  8. Provider Business Mailing Address City Name
  9. Provider Business Mailing Address State Name
  10. Provider Business Mailing Address Postal Code
  11. Provider Business Mailing Address Country Code If outside U S
  12. Provider Business Mailing Address Telephone Number
  13. Provider Business Mailing Address Fax Number
  14. Provider First Line Business Practice Location Address
  15. Provider Business Practice Location Address City Name
  16. Provider Business Practice Location Address State Name
  17. Provider Business Practice Location Address Postal Code
  18. Provider Business Practice Location Address Country Code If outside U S
  19. Provider Business Practice Location Address Telephone Number
  20. Provider Business Practice Location Address Fax Number
  21. Provider Enumeration Date
  22. Last Update Date
  23. Authorized Official Last Name
  24. Authorized Official First Name
  25. Authorized Official Title or Position
  26. Authorized Official Telephone Number
  27. Healthcare Provider Taxonomy Code 1
  28. Provider License Number 1
  29. Provider License Number State Code 1
  30. Healthcare Provider Primary Taxonomy Switch 1
  31. Healthcare Provider Taxonomy Code 2
  32. Provider License Number 2
  33. Provider License Number State Code 2
  34. Healthcare Provider Primary Taxonomy Switch 2
  35. Healthcare Provider Taxonomy Code 3
  36. Provider License Number 3
  37. Provider License Number State Code 3
  38. Healthcare Provider Primary Taxonomy Switch 3
  39. Healthcare Provider Taxonomy Code 4
  40. Provider License Number 4
  41. Provider License Number State Code 4
  42. Healthcare Provider Primary Taxonomy Switch 4
  43. Is Organization Subpart
  44. Authorized Official Credential Text
  45. Healthcare Provider Taxonomy Group 1
  46. Healthcare Provider Taxonomy Group 2
  47. Healthcare Provider Taxonomy Group 3
  48. Healthcare Provider Taxonomy Group 4

Complete NPI Dataset

This page represents the complete record for NPI 1316468176. You can access the complete dataset, including a full list of field names, along with their values, and definitions as recorded by the NPI registry. Each field in the NPI record is explained, highlighting its significance and the possible values it can hold.

NPI: 1316468176
The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
Entity Type Code: 2
Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
Employer Identification Number EIN: UNAVAIL
The Employer Identification Number (EIN), assigned by the IRS, of the provider being identified.
The name of the organization provider. If the provider is an organization, this is the legal business name.
Provider Other Organization Name: OPTOMETRIC CENTER AND EYEWEAR GALLERIA
Other name by which the organization provider is or has been known.
Provider Other Organization Name Type Code: 3
Code identifying the type of other name. Codes are: 1 = former name; 2 = professional name; 3 = doing business as (d/b/ a) name; 4 = former legal business name; 5 = other.
Provider First Line Business Mailing Address: 2551 SAN RAMON VALLEY BLVD STE 101
The first line mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider first line location address’’.
Provider Business Mailing Address City Name: SAN RAMON
The city name in the mailing address of the provider being identified.
Provider Business Mailing Address State Name: CA
The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address State name’’.
Provider Business Mailing Address Postal Code: 945831661
The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as ‘‘Provider location address postal code’’.
Provider Business Mailing Address Country Code If outside U S : US
The country code in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address country code’’.
Provider Business Mailing Address Telephone Number: 9257431222
The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address telephone number’’.
Provider Business Mailing Address Fax Number: 9257431221
The fax number associated with the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address fax number’’.
Provider First Line Business Practice Location Address: 2551 SAN RAMON VALLEY BLVD STE 101
The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Business Practice Location Address City Name: SAN RAMON
The city name in the location address of the provider being identified.
Provider Business Practice Location Address State Name: CA
The State code in the location of the provider being identified.
Provider Business Practice Location Address Postal Code: 945831661
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
Provider Business Practice Location Address Country Code If outside U S : US
The country code in the location address of the provider being identified.
Provider Business Practice Location Address Telephone Number: 9257431222
The telephone number associated with the location address of the provider being identified.
Provider Business Practice Location Address Fax Number: 9257431221
The fax number associated with the location address of the provider being identified.
Provider Enumeration Date: 7/3/2017
The date the provider was assigned a unique identifier (assigned an NPI).
Last Update Date: 7/21/2022
The date that a record was last updated or changed.
Authorized Official Last Name: FAULKNER
The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider.
Authorized Official First Name: LYNDSY
The first name of the authorized official.
Authorized Official Title or Position: ACCOUNTS MANAGER
The title or position of the authorized official.
Authorized Official Telephone Number: 9257431222
The 10-position telephone number of the authorized official.
Healthcare Provider Taxonomy Code 1: 152W00000X
Code designating the provider type, classification, and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1.
Provider License Number 1: 5287T
The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’.
Provider License Number State Code 1: CA
The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number.
Healthcare Provider Primary Taxonomy Switch 1: N
Healthcare Provider Taxonomy Code 2: 152WC0802X
Provider License Number 2: 14540TLG
The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’.
Provider License Number State Code 2: CA
The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number.
Healthcare Provider Primary Taxonomy Switch 2: N
Healthcare Provider Taxonomy Code 3: 152WP0200X
Provider License Number 3: 14540TLG
The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’.
Provider License Number State Code 3: CA
The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number.
Healthcare Provider Primary Taxonomy Switch 3: N
Healthcare Provider Taxonomy Code 4: 152W00000X
Provider License Number 4: 14540TLG
The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’.
Provider License Number State Code 4: CA
The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number.
Healthcare Provider Primary Taxonomy Switch 4: Y
Is Organization Subpart: N
Authorized Official Credential Text: CPOC
Healthcare Provider Taxonomy Group 1: 193200000X MULTI-SPECIALTY GROUP
Healthcare Provider Taxonomy Group 2: 193200000X MULTI-SPECIALTY GROUP
Healthcare Provider Taxonomy Group 3: 193200000X MULTI-SPECIALTY GROUP
Healthcare Provider Taxonomy Group 4: 193200000X MULTI-SPECIALTY GROUP