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1043915788 NPI number — PACIFIC RETINA INC

NPI Number: 1043915788
Health Care Provider/Practitioner: PACIFIC RETINA INC

Information about “1043915788” NPI (PACIFIC RETINA INC) exists in 1043915788 in HTML format HTML  |  1043915788 in plain Text format TXT  |  1043915788 in PDF (Portable Document Format) PDF  |  1043915788 in an XML format XML  formats.

NPI Number : 1043915788 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1043915788",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "PACIFIC RETINA INC",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "7152 BON VILLA CIR",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "LA PALMA",
    "MailingAddressStateName": "CA",
    "MailingAddressPostalCode": "90623-1167",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "714-732-1417",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "1109 S PARK VICTORIA DR",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "MILPITAS",
    "PracticeLocationAddressStateName": "CA",
    "PracticeLocationAddressPostalCode": "95035-6942",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "714-732-1417",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "04/03/2023",
    "LastUpdateDate": "10/24/2024",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "SHAH",
    "AuthorizedOfficialFirstName": "SANKET",
    "AuthorizedOfficialMiddleName": "U",
    "AuthorizedOfficialTitle": "PHYSICIAN",
    "AuthorizedOfficialNamePrefix": "DR.",
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "MD",
    "AuthorizedOfficialTelephoneNumber": "714-732-1417",
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "207W00000X",
          "TaxonomyName": "Ophthalmology Physician",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "207WX0107X",
          "TaxonomyName": "Retina Specialist (Ophthalmology) Physician",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": [
        {
          "HealthcareProviderTaxonomyGroupName": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
          "HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
        },
        {
          "HealthcareProviderTaxonomyGroupName": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
          "HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
        }
      ]
    }
  }
}
                
            

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