TEDDER OPTOMETRY GROUP, PC
NPI 1184484222
Optometrist in San Dimas, CA
About Tedder Optometry Group, Pc NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
TEDDER OPTOMETRY GROUP, PC (NPI 1184484222) is a healthcare organization registered as an optometrist in San Dimas, California and active in the NPI registry since March 2024. The organization lists Kimberly Tedder, Ceo, as its authorized official.
NPPES Registry Identity
Specialties & Licenses
Group Practice 1
Medicare Participation & PECOS CMS
Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Tedder Optometry Group, Pc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Clinicians Billing Medicare Through This Organization
6Medicare enrollment records show 6 clinicians reassign Medicare billing to Tedder Optometry Group, PC, which bills Medicare for the services they deliver. They are listed nearest first.
Clinicians, nearest first (6)
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Frequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Tedder Optometry Group, PC's NPI number?
The NPI number for Tedder Optometry Group, PC is 1184484222. It was assigned to this organization in the NPPES registry on March 19, 2024.
Where is Tedder Optometry Group, PC located?
Tedder Optometry Group, PC is located at 939 W Arrow Hwy, San Dimas, CA 91773. The listed phone number is (805) 624-1255.
What is Tedder Optometry Group, PC's specialty?
The primary specialty registered for this NPI is Optometrist with taxonomy code 152W00000X.
Is Tedder Optometry Group, PC enrolled in Medicare?
Yes. Tedder Optometry Group, PC is registered in the Medicare PECOS enrollment system.
How many clinicians bill Medicare through Tedder Optometry Group, PC?
According to the CMS Revalidation Reassignment List (October 2026 release), 6 clinicians, all in Optometry, reassign their Medicare billing to Tedder Optometry Group, PC. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
When was this NPI record last updated?
The NPPES record for Tedder Optometry Group, PC was last updated on September 23, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Tedder Optometry Group, Pc · NPI 1184484222
Optometrist organization in San Dimas, California. Organization record, active in the CMS NPPES registry since March 19, 2024.
## Identity
- **NPI:** 1184484222 (Entity type: Organization)
- **Enumerated:** March 19, 2024
- **Primary specialty:** Optometrist · taxonomy 152W00000X
- **Organization subpart:** No
- **Authorized official:** Kimberly Tedder, CEO
## Practice location
- **Address:** 939 W ARROW HWY, San Dimas, CA 91773-2410
- **Phone:** (805) 624-1255
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Clinicians billing through this organization:** 6 clinicians (Optometry) reassign Medicare billing to this organization (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** September 23, 2024
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Source: [NPI Profile](https://npiprofile.com/npi/1184484222) · Data from the CMS NPPES public registry.