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RETINAL DIAGNOSTIC CENTER A MEDICAL CORPORATION NPI 1518030568


NPI Information

NPI: 1518030568
Provider Name: RETINAL DIAGNOSTIC CENTER A MEDICAL CORPORATION
Classification: Specialist - 174400000X
Entity Type: Organization

CLIA Number: 05D1073861

Address:
3395 S. BASCOM AVE.
SUITE 140
CAMPBELL, CA
ZIP 95008
Phone: (408) 559-0666
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RETINAL DIAGNOSTIC CENTER A MEDICAL CORPORATION is a specialist in Campbell, CA. The provider is an individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. RETINAL DIAGNOSTIC CENTER A MEDICAL CORPORATION NPI is 1518030568. The provider is registered as an organization entity type and is a multiple single specialty group.

The provider's business location address is:

3395 S. BASCOM AVE.
SUITE 140
CAMPBELL, CA
ZIP 95008
Phone: (408) 559-0666
Fax: (408) 963-5920

The provider's authorized official is Tim Kelley .
The authorized official title is Office Manager and has the following contact phone number (408) 559-0666.

The CLIA number assigned to this NPI record is 05D1073861 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 11/16/2006 and was last updated on 7/19/2023.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1174400000XSpecialistG60723CALIFORNIANo
2174400000XSpecialistG83824CALIFORNIANo
3174400000XSpecialistA53889CALIFORNIANo
4174400000XSpecialistC37086CALIFORNIAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
100G838240MEDICAIDCALIFORNIA
200G607230MEDICAIDCALIFORNIA
300C370860MEDICAIDCALIFORNIA
400A538890MEDICAIDCALIFORNIA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.