Samantha Makpaiboonvatana

Primary specialty

OptometristTaxonomy code 152W00000X

License

33980TLG Issued in CA

Practice address

1909 N Waterman Ave Ste 3
San Bernardino, CA 92404

Phone

(909) 882-8883

NPI assigned

Jun 9, 2018

Sex

Female

Sole proprietor

No

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

Specialty

Optometry

Education

Southern California College of Optometry, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Gintien Huang MD IncGroup PAC ID 7214269646, 6 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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

• Gintien Huang MD Inc

  dba San Bernardino Eye Specialists

  • Ophthalmology Physician
  • San Bernardino, CA
  • NPI 1609437599

  Optometrist

  Medicare reassignment Care Compare group NPD
• Ayaz O Khan Inc

  • Ophthalmology Physician
  • Pomona, CA
  • NPI 1558720516
  NPD

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

{
    "created_epoch": "1528502400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1625356800000",
    "number": "1043703564",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1909 N WATERMAN AVE STE 3",
            "city": "SAN BERNARDINO",
            "state": "CA",
            "postal_code": "924044842"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1909 N WATERMAN AVE STE 3",
            "city": "SAN BERNARDINO",
            "state": "CA",
            "postal_code": "92404",
            "telephone_number": "909-882-8883"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAKPAIBOONVATANA",
        "first_name": "SAMANTHA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-06-09",
        "last_updated": "2021-07-04",
        "certification_date": "2021-07-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "33980TLG",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Waheed Majeed
• Mingon Valencia Major Lance, RADT
• Dewayne David Majourau, BREINING INSTITUTE
• Antora Otithia Majumder
• Ahmedali Y Makati, D.D.S.
• Luz Maldonado Torres
• Breanne Maldonado
• Crystal Maldonado
• Yvonne Maldonado
• Mia Y Maldonaldo

• Optometrist in San Bernardino, CA
• Providers in San Bernardino, CA by specialty
• Optometrist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 4, 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.