Individual provider Active NPI

Kathy Mao, O.D.

  • Optometrist
  • Santa Ana, CA
National Provider Identifier
1053830158
Registry record updated Aug 21, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
OPT33828-TLG Issued in CA
Practice address
1206 E 17TH St Ste 101
Santa Ana, CA 92701-2641
Phone
(714) 352-2911
Fax
(714) 352-2903
NPI assigned
Sep 11, 2017
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 21, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X OPT33828-TLG CA Primary

Addresses

Primary practice location

1206 E 17TH St Ste 101
Santa Ana, CA 92701-2641

Mailing address

1206 E 17TH St Ste 101
Santa Ana, CA 92701-2641
Phone (714) 352-2911

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
I20180223001709 CA Practitioner - Optometry 9638430101 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Serve the People, Inc.Group PAC ID 4880872795, 5 clinicians

Practice addresses (Care Compare)

1206 E 17TH St
Suite 101
Santa Ana, CA 92701-2641
Phone (714) 352-2911

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
OPT33828-TLGCAMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Serve the People, Inc CurrentSince Nov 1, 2024 Accepting new patients
De la Pena Eye Clinic, a Medical Group, Inc. Optometrist Past Accepting new patients

Locations

1206 E 17th St
Ste 101
Santa Ana, CA 92701
Phone (714) 352-2911

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Organizations & group practices 2

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": "1505088000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1755734400000",
    "number": "1053830158",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1206 E 17TH ST STE 101",
            "city": "SANTA ANA",
            "state": "CA",
            "postal_code": "927012641",
            "telephone_number": "714-352-2911",
            "fax_number": "714-352-2903"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1206 E 17TH ST STE 101",
            "city": "SANTA ANA",
            "state": "CA",
            "postal_code": "927012641",
            "telephone_number": "714-352-2911",
            "fax_number": "714-352-2903"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAO",
        "first_name": "KATHY",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-09-11",
        "last_updated": "2025-08-21",
        "certification_date": "2025-08-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "OPT33828-TLG",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Santa Ana, CA

Sources for this page

Verify at the official NPI Registry.