Summit Optometric Eyecare

Primary specialty

OptometristTaxonomy code 152W00000X

License

11209T Issued in CA

Legal business name

SUMMIT OPTOMETRIC EYECARE

Practice address

690 E Los Angeles Ave
Suite a
Simi Valley, CA 93065-1857

Phone

(626) 376-3513

Fax

(805) 250-1001

NPI assigned

May 16, 2013

Organization subpart

No

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

Authorized official

Name

Dr. John Ilsun Ryu, O.D.NPI 1609946847

Title

Ceo/Optometrist

Phone

(626) 376-3513

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Practitioners 1

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

• John Ilsun Ryu, O.D.

  • Optometrist
  • Simi Valley, CA
  • NPI 1609946847
  Medicare reassignment Authorized official

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

{
    "created_epoch": "1368662400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1375660800000",
    "number": "1053757039",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "690 E LOS ANGELES AVE",
            "address_2": "SUITE A",
            "city": "SIMI VALLEY",
            "state": "CA",
            "postal_code": "930651857",
            "telephone_number": "626-376-3513",
            "fax_number": "805-250-1001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "690 E LOS ANGELES AVE",
            "address_2": "SUITE A",
            "city": "SIMI VALLEY",
            "state": "CA",
            "postal_code": "930651857",
            "telephone_number": "626-376-3513",
            "fax_number": "805-250-1001"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUMMIT OPTOMETRIC EYECARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-05-16",
        "last_updated": "2013-08-05",
        "status": "A",
        "authorized_official_last_name": "RYU",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "ILSUN",
        "authorized_official_title_or_position": "CEO/OPTOMETRIST",
        "authorized_official_telephone_number": "626-376-3513",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "CA",
            "license": "11209T",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kristeen Marie Succa, MS, BCBA
• Jan Suckut, D.C.
• Melanie Suljada, NP
• Maral Pushian Sultanian, LMFT
• Summit Home Health, Inc
• Li Sun
• Nancy Sun, M.D.
• Nichole Sun, DDS, MS
• Megha Sundar, LMFT
• Sunlight Home Health Care Inc

• Optometrist in Simi Valley, CA
• Providers in Simi Valley, CA by specialty
• Optometrist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.