Jacqueline Nguyen

Primary specialty

OptometristTaxonomy code 152W00000X

License

34551 Issued in CA

Practice address

350 Walters Rd
Suisun City, CA 94585-3043

Phone

(510) 854-9876

NPI assigned

Mar 17, 2020

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

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

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Lawrence Glen Mock, OD

  • Optometrist
  • Walnut Creek, CA
  • NPI 1164419149
  Medicare reassignment
• Lawrence G Mock, O.D.

  • Optometrist
  • Walnut Creek, CA
  • NPI 1114107802
  NPD (past)

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

{
    "created_epoch": "1584403200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1611705600000",
    "number": "1033745468",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "350 WALTERS RD",
            "city": "SUISUN CITY",
            "state": "CA",
            "postal_code": "945853043",
            "telephone_number": "707-234-5564",
            "fax_number": "707-666-6070"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "350 WALTERS RD",
            "city": "SUISUN CITY",
            "state": "CA",
            "postal_code": "945853043",
            "telephone_number": "510-854-9876"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NGUYEN",
        "first_name": "JACQUELINE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-03-17",
        "last_updated": "2021-01-27",
        "certification_date": "2021-01-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "34551",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• MCN Transportation Service
• Shakeem Malik Miller
• Jeremiah Nash
• Latrease Lazette Newman
• Anh-Tu Dinh Nguyen, PHARMD
• Robert Daniel Nicholas III, CRNA
• Anquanitte Darlene Ortega
• Kenya N Owens
• Paradise Adolescent Homes, Inc.
• Emma Concepcion Santero Parayno, RPH

• Optometrist in Suisun City, CA
• Providers in Suisun City, CA by specialty
• Optometrist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 27, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.