Queen Lucky Thach, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

OPT33685-TLG Issued in CA

Practice address

2907 Jamacha Rd Ste a
El Cajon, CA 92019-4342

Phone

(619) 660-0272

Fax

(619) 660-0310

NPI assigned

Jun 18, 2017

Last updated

Apr 15, 2021By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in CA, NY, TX3 enrollments

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 3

Specialty

Optometry

Education

Nova Southeastern Univ College of Dental Medicine, 2017

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Total Vision PCGroup PAC ID 9234472242, 115 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations (25 of 27)

Networks

• BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

• Direct secure messaging: qthach@retinadrs.intellechartdirect.net
• Direct secure messaging: qthach54876@syhealth.direct-ci.com

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.

• Total Vision PC

  dba Total Vision

  • Optometrist
  • San Diego, CA
  • NPI 1356813711
  Medicare reassignment Care Compare group NPD
• Centro de Salud de la Comunidad de San Ysidro, Inc.

  dba San Ysidro Health Precision Park

  • Federally Qualified Health Center (FQHC)
  • San Diego, CA
  • NPI 1124782685
  Medicare reassignment NPD
• Eye Center Optometrics, a Professional Corporation

  • Optometrist
  • Citrus Heights, CA
  • NPI 1245369024
  Medicare reassignment NPD
• Fifth Optometric Care of California

  • Optometrist
  • San Jose, CA
  • NPI 1215627914
  Medicare reassignment NPD
• Southern Indian Health Council

  • Health Service Clinic/Center
  • Campo, CA
  • NPI 1922090885

  TX

  Medicare reassignment NPD
• Ejmvkk Associates Inc

  dba Pearle Vision

  • Optometrist
  • Ozone Park, NY
  • NPI 1992189153
  Medicare reassignment NPD
• Empire Vision Center Inc

  dba Davis Vision

  • Optometrist
  • Syracuse, NY
  • NPI 1750358826
  Medicare reassignment NPD
• Framebar Co LLC

  • Optometrist
  • Oceanside, NY
  • NPI 1295384139
  Medicare reassignment NPD
• Eyemd on Cass a Professional Corporation

  • Optometrist
  • Monterey, CA
  • NPI 1205095742
  Medicare reassignment
• Afsaneh Amini, O.D., a Professional Optometric Corporation

  dba American Eye Optometry

  • Optometrist
  • Escondido, CA
  • NPI 1598581217
  NPD
• California Retina Associates, LP

  dba California Retina Associates

  • Ophthalmology Physician
  • Chula Vista, CA
  • NPI 1114033404
  NPD
• Centro de Salud de la Comunidad de San Ysidro Inc

  dba San Ysidro Health Senior Dental Center

  • Federally Qualified Health Center (FQHC)
  • San Diego, CA
  • NPI 1457033813
  NPD

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

{
    "created_epoch": "1497744000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1618444800000",
    "number": "1053841478",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7419 CAMINITO CARLOTTA",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921202216"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2907 JAMACHA RD STE A",
            "city": "EL CAJON",
            "state": "CA",
            "postal_code": "920194342",
            "telephone_number": "619-660-0272",
            "fax_number": "619-660-0310"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THACH",
        "first_name": "QUEEN",
        "middle_name": "LUCKY",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-06-18",
        "last_updated": "2021-04-15",
        "certification_date": "2021-03-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NY",
            "license": "TUV009101-01",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "OPT33685-TLG",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Selevia Tepo
• Terry Winegar MD Inc.
• Marlo Dean Terry
• Margaret R Tess, PH.D.
• Steven Reinhold Tess, PH.D.
• Maria Ann Tharakan, RN
• Tharon San Diego LLC
• The Constellation
• The Future Pharmacy Inc. (Family Pharmacy)
• The Future Pharmacy Inc. (Family Pharmacy at Home)

• Optometrist in El Cajon, CA
• Providers in El Cajon, CA by specialty
• Optometrist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 15, 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.