EMPIRE EYE DOCTORS MEDICAL GROUP INC (NPI# 1003806068) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1003806068 |
| Entity Type | Organization |
| Organization Name | EMPIRE EYE DOCTORS MEDICAL GROUP INC |
| Practice Address |
720 4th St Santa Rosa CA 95404-4421 |
| Practice Telephone | 7075753800 |
| Practice Fax Number | 7075284967 |
| Mailing Telephone | 7075753800 |
| Mailing Fax Number | 7075284967 |
| Enumeration Date | 2005-10-21 |
| Last Update Date | 2008-05-01 |
| Authorized Official Name | PENNY DOW (BILLING MANAGER) |
| Authorized Official Telephone | 7075753800 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 152W00000X | Optometrist | 8739T | CA | Eye and Vision Services Providers |
| N | 152WL0500X |
Optometrist Specialization: Low Vision Rehabilitation |
8817T | CA | Eye and Vision Services Providers |
| N | 207W00000X | Ophthalmology | G57122 | CA | Allopathic & Osteopathic Physicians |
| N | 207W00000X | Ophthalmology | G32019 | CA | Allopathic & Osteopathic Physicians |
| Y | 207W00000X | Ophthalmology | G32243 | CA | Allopathic & Osteopathic Physicians |
| N | 152W00000X | Optometrist | T10471 | CA | Eye and Vision Services Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CA | GR0016130 | 05 | |
| CA | RAILROAD MEDICARE | CP5395 | 01 |
| Street Address |
720 4TH ST |
| City | SANTA ROSA |
| State | CA |
| Zip Code | 95404-4421 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023008075 | Dan R Lightfoot | Ophthalmology | 720 4th St, Santa Rosa, CA 95404-4421 | 2005-10-21 |
| 1083141857 | Eye Care Institute, A Medical Corporation | Optometrist | 720 4th St, Santa Rosa, CA 95404-4421 | 2017-05-11 |
| 1568840759 | Northern California Medical Assoc Inc | Ophthalmology | 720 4th St, Santa Rosa, CA 95404-4421 | 2015-05-08 |
| 1982732939 | Susan Hewlett | Optometrist | 720 4th St, Santa Rosa, CA 95404-4421 | 2007-03-01 |
| 1649293192 | Stewart I Wolfe | Optometrist | 720 4th St, Santa Rosa, CA 95404-4421 | 2006-07-25 |
| 1649260696 | David V Lightfoot | Ophthalmology | 720 4th St, Santa Rosa, CA 95404-4421 | 2005-10-21 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205442217 | David Lee Dutton | Counselor | 201 S. E Street, Santa Rosa, CA 95404 | 2020-09-16 |
| 1114492162 | Jesse Earl Rathbun Jr. | Ophthalmology | 1920 Grace Dr., Santa Rosa, CA 95404 | 2018-10-05 |
| 1568958437 | Bianca Avina | Marriage & Family Therapist | 95 Montgomery Dr. #112, Santa Rosa, CA 95404 | 2018-07-03 |
| 1366940504 | New Leaf Counseling and Psychotherapy | Marriage & Family Therapist | 1030 2n Street, Suite B, Santa Rosa, CA 95404 | 2018-01-23 |
| 1659884864 | Jessica Vargas Lopez | Counselor | 3333 Chanate Road, Santa Rosa, CA 95404 | 2017-11-09 |
| 1982135992 | Gaea Keridwyn Coon | Marriage & Family Therapist | 884 Third Street, Suite D, Santa Rosa, CA 95404 | 2017-03-22 |
| 1376084699 | Empire Traditional Chinese Medicine | Acupuncturist | 1030 Second St, Santa Rosa, CA 95404 | 2017-03-20 |
| 1356888705 | Webster Surgery Center, Lp | Clinic/Center | 730 Bennett Valley Road, Santa Rosa, CA 95404 | 2017-01-24 |
| 1205295979 | Sandra Lee Krikorian | Social Worker | 101 E Street, Suite 312, Santa Rosa, CA 95404 | 2016-02-23 |
| 1396134615 | The Center for Body Oriented Psychotherapy & Wellness | Psychologist | 1626 Fourth Street, Santa Rosa, CA 95404 | 2015-01-12 |
| Find all providers in zip 95404 | ||||
| Taxonomy Code | 207W00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Ophthalmology |
| An ophthalmologist has the knowledge and professional skills needed to provide comprehensive eye and vision care. Ophthalmologists are medically trained to diagnose, monitor and medically or surgically treat all ocular and visual disorders. This includes problems affecting the eye and its component structures, the eyelids, the orbit and the visual pathways. In so doing, an ophthalmologist prescribes vision services, including glasses and contact lenses. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Ophthalmology, 2007. http://www.abop.org/. American Osteopathic Board of Ophthalmology and Otolaryngology, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Ophthalmology. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Ophthalmology and Otolaryngology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1114492162 | Jesse Earl Rathbun Jr. | Ophthalmology | 1920 Grace Dr., Santa Rosa, CA 95404 | 2018-10-05 |
| 1952670796 | Cole Phillip Stephens | Ophthalmology | 4711 Hillsboro Cir, Santa Rosa, CA 95405-8776 | 2011-12-23 |
| 1194024935 | John Lawrence Norris | Ophthalmology | 1415 Olivet Rd, Santa Rosa, CA 95401-3810 | 2011-03-18 |
| 1487785101 | Valerie Sondra Garden | Ophthalmology | 1140 Sonoma Avenue, Building 2a, Santa Rosa, CA 95405-4817 | 2007-03-07 |
| 1770509002 | Mark Edwin Jacobson | Ophthalmology | 1260 N Dutton Ave Ste 160, Santa Rosa, CA 95401-7139 | 2006-07-13 |
| 1346275484 | Sanjay Bansal | Ophthalmology | 3540 Mendocino Avenue, Suite 200, Santa Rosa, CA 95403-3639 | 2006-07-11 |
| 1003851809 | Alice Chiang | Ophthalmology | 1002 Mendocino Ave, Santa Rosa, CA 95401-4330 | 2006-06-17 |
| 1720042617 | David E. Ulmer | Ophthalmology | 990 Sonoma Ave, Ste 10, Santa Rosa, CA 95404-4802 | 2006-04-17 |
| 1972566842 | Brien A. Seeley | Ophthalmology | 4739 Hoen Ave, Santa Rosa, CA 95405-7862 | 2006-04-10 |
| 1326010620 | James E Hunt | Ophthalmology | 1140 Sonoma Ave Ste 2, Santa Rosa, CA 95405-4817 | 2006-02-02 |
| Find all providers in SANTA ROSA | ||||
| City | SANTA ROSA |
| Zip Code | 95404 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.