Individual provider Active NPI

Calvin Tan, O.D.

  • Optometrist
  • Pasadena, CA
National Provider Identifier
1043507643
Registry record updated Oct 24, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
14313TLG Issued in CA
Practice address
477 E Colorado Blvd
Pasadena, CA 91101-2024
Phone
(626) 796-1191
Fax
(626) 796-0189
NPI assigned
Jul 3, 2011
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 24, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 14313TLG CA Primary

Addresses

Primary practice location

477 E Colorado Blvd
Pasadena, CA 91101-2024

Mailing address

477 E Colorado Blvd
Pasadena, CA 91101-2024
Phone (626) 796-1191

Electronic endpoints 1

TypeEndpointUseAffiliation
SOAP URL https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq Health Information Exchange (HIE) Southern California Permanente Medical Group

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
I20120612000616 CA Practitioner - Optometry 0749444289 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
State University of New York - State College Optometry, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Southern California Permanente Medical GroupGroup PAC ID 6002729175, 11,250 clinicians

Practice addresses (Care Compare)

15446 S Western Ave
Gardena, CA 90249-4319
Phone (310) 217-5300

25821 Vermont Ave
Harbor City, CA 90710-3518
Phone (310) 325-5111

25825 Vermont Ave
Harbor City, CA 90710-3518
Phone (310) 325-5111

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
14313TLGCAMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Southern California Permanente Medical Group CurrentSince Jan 18, 2016 Accepting new patients
Linden Optometry a Professional Corporation Optometrist CurrentSince Jun 29, 2015 Accepting new patients
Southern California Permanente Medical Group Current Accepting new patients
Southern California Permanente Medical Group CurrentSince Jan 18, 2016 Accepting new patients
Dr. Arlene T. Yepremian, O.D. a Professional Corporation Optometrist PastSince Jun 29, 2015 Accepting new patients

Locations

25825 Vermont Ave
Harbor City, CA 90710
Phone (310) 325-5111

6041 Cadillac Ave
Los Angeles, CA 90034
Phone (323) 857-2000

4733 W Sunset Blvd
Los Angeles, CA 90027
Phone (213) 667-4784

477 E Colorado Blvd
Pasadena, CA 91101
Phone (626) 796-1191

393 E Walnut St
Unit 3RD
Pasadena, CA 91188
Phone (626) 405-7914

Interoperability endpoints

  • Direct secure messaging: calvin.tan.p1@direct.valleyeyecenter.nextgenshare.com
  • Direct secure messaging: calvin.tan.p3@direct.valleyeyecenter.nextgenshare.com

Organizations & group practices 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1309651200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1635033600000",
    "number": "1043507643",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "477 E COLORADO BLVD",
            "city": "PASADENA",
            "state": "CA",
            "postal_code": "911012024",
            "telephone_number": "626-796-1191",
            "fax_number": "626-796-0189"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "477 E COLORADO BLVD",
            "city": "PASADENA",
            "state": "CA",
            "postal_code": "911012024",
            "telephone_number": "626-796-1191",
            "fax_number": "626-796-0189"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TAN",
        "first_name": "CALVIN",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2011-07-03",
        "last_updated": "2021-10-24",
        "certification_date": "2021-10-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "14313TLG",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq",
            "affiliation": "Y",
            "endpointDescription": "Carequality",
            "affiliationName": "Southern California Permanente Medical Group",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "25825 Vermont Ave",
            "city": "Harbor City",
            "state": "CA",
            "country_code": "US",
            "postal_code": "907103518",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Pasadena, CA

Sources for this page

Verify at the official NPI Registry.