Individual provider Active NPI

David Tadao Wakabayashi, O.D.

  • Optometrist
  • Irvine, CA
National Provider Identifier
1013072396
Registry record updated Aug 3, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
OPT5223TLG Issued in CA
Practice address
14150 Culver Dr Ste 207
Irvine, CA 92604-0323
Phone
(949) 552-2020
Fax
(949) 552-6777
NPI assigned
Dec 27, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 3, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X OPT5223TLG CA Primary

Addresses

Primary practice location

14150 Culver Dr Ste 207
Irvine, CA 92604-0323

Mailing address

14150 Culver Dr Ste 207
Irvine, CA 92604-0323
Phone (949) 552-2020

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20031117000312 CA Practitioner - Optometry 0941114755 Receives reassigned benefits from 1 practitioner
Practice locations: Irvine, CA

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Other, 1970
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

14150 Culver Dr
Suite 207
Irvine, CA 92604-0323
Phone (949) 552-2020

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
OPT5223TLGCAMDOptometrist
5223CAMDSpeech-Language Assistant

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1167177600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1659484800000",
    "number": "1013072396",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14150 CULVER DR STE 207",
            "city": "IRVINE",
            "state": "CA",
            "postal_code": "926040323",
            "telephone_number": "949-552-2020",
            "fax_number": "949-552-6777"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14150 CULVER DR STE 207",
            "city": "IRVINE",
            "state": "CA",
            "postal_code": "926040323",
            "telephone_number": "949-552-2020",
            "fax_number": "949-552-6777"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAKABAYASHI",
        "first_name": "DAVID",
        "middle_name": "TADAO",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-12-27",
        "last_updated": "2022-08-03",
        "certification_date": "2022-08-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "OPT5223TLG",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Irvine, CA

Sources for this page

Verify at the official NPI Registry.