NPI Code Detail JSON Logo

1124290721 NPI number — FRED WM STELLHORN OPTOMETRIC CORPORATION

NPI Number: 1124290721
Health Care Provider/Practitioner: FRED WM STELLHORN OPTOMETRIC CORPORATION

Information about “1124290721” NPI (FRED WM STELLHORN OPTOMETRIC CORPORATION) exists in 1124290721 in HTML format HTML  |  1124290721 in plain Text format TXT  |  1124290721 in PDF (Portable Document Format) PDF  |  1124290721 in an XML format XML  formats.

NPI Number : 1124290721 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1124290721",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "FRED WM STELLHORN OPTOMETRIC CORPORATION",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": "6",
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "140 N FREMONT ST STE A",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "MANTECA",
    "MailingAddressStateName": "CA",
    "MailingAddressPostalCode": "95336-4729",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "209-823-3151",
    "MailingAddressFaxNumber": "209-823-9712",
    "FirstLinePracticeLocationAddress": "140 N FREMONT ST STE A",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "MANTECA",
    "PracticeLocationAddressStateName": "CA",
    "PracticeLocationAddressPostalCode": "95336-4729",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "209-823-3151",
    "PracticeLocationAddressFaxNumber": "209-823-9712",
    "EnumerationDate": "03/24/2008",
    "LastUpdateDate": "08/25/2016",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "STELLHORN",
    "AuthorizedOfficialFirstName": "FREDERICK",
    "AuthorizedOfficialMiddleName": "WILLIAM",
    "AuthorizedOfficialTitle": "OPTOMETRIST",
    "AuthorizedOfficialNamePrefix": "DR.",
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "O.D.",
    "AuthorizedOfficialTelephoneNumber": "209-823-3151",
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "152WC0802X",
          "TaxonomyName": "Corneal and Contact Management Optometrist",
          "LicenseNumber": "5215 TPL",
          "LicenseNumberStateCode": "CA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "152WL0500X",
          "TaxonomyName": "Low Vision Rehabilitation Optometrist",
          "LicenseNumber": "5215 TPL",
          "LicenseNumberStateCode": "CA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "152WP0200X",
          "TaxonomyName": "Pediatric Optometrist",
          "LicenseNumber": "5215 TPL",
          "LicenseNumberStateCode": "CA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "152WS0006X",
          "TaxonomyName": "Sports Vision Optometrist",
          "LicenseNumber": "5215 TPL",
          "LicenseNumberStateCode": "CA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "152WV0400X",
          "TaxonomyName": "Vision Therapy Optometrist",
          "LicenseNumber": "5215 TPL",
          "LicenseNumberStateCode": "CA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "152WX0102X",
          "TaxonomyName": "Occupational Vision Optometrist",
          "LicenseNumber": "5215 TPL",
          "LicenseNumberStateCode": "CA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "152W00000X",
          "TaxonomyName": "Optometrist",
          "LicenseNumber": "5215 TPL",
          "LicenseNumberStateCode": "CA",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": [
        {
          "HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
          "HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
        },
        {
          "HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
          "HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
        },
        {
          "HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
          "HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
        },
        {
          "HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
          "HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
        },
        {
          "HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
          "HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
        },
        {
          "HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
          "HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
        },
        {
          "HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
          "HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
        }
      ]
    }
  }
}
                
            

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