Individual provider Active NPI

Christine Pham

  • Optometrist
  • Pomona, CA
National Provider Identifier
1063830412
Registry record updated Nov 2, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
OPT15386TLG Issued in CA
Practice address
795 E. Second Street
Suite 2
Pomona, CA 91766-2007
Phone
(909) 706-3899
Fax
(909) 469-8640
NPI assigned
Apr 2, 2014
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 2, 2016

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X OPT15386TLG CA Primary
Corneal and Contact Management Optometrist 152WC0802X 15386TLG CA

Addresses

Primary practice location

795 E. Second Street
Suite 2
Pomona, CA 91766-2007

Mailing address

795 E. Second Street
Suite 2
Pomona, CA 91766-2007
Phone (909) 469-8773

Other identifiers 1

IdentifierTypeStateIssuer
CB243539OtherCAMEDICARE PTAN SO CAL

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
I20151013001053 CA Practitioner - Optometry 7618197682 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

795 E 2ND St
Pomona, CA 91766-2007
Phone (909) 469-8673

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
OPT15386TLGCAMDOptometrist
15386TLGCAMDCorneal and Contact Management Optometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Western University of Health Sciences Current Accepting new patients
Western University of Health Sciences Optometrist CurrentSince Sep 8, 2015 Accepting new patients
Western University of Health Sciences CurrentSince Sep 8, 2015 Accepting new patients

Locations

795 E 2nd St
Ste 2
Pomona, CA 91766
Phone (909) 469-8673

795 E 2nd St
Ste 5
Pomona, CA 91766
Phone (909) 706-3877

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

  • Direct secure messaging: cpham195834@direct.ochin.org

Organizations & group practices 3

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": "1396396800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1478044800000",
    "number": "1063830412",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "795 E. SECOND STREET",
            "address_2": "SUITE 2",
            "city": "POMONA",
            "state": "CA",
            "postal_code": "917662007",
            "telephone_number": "909-469-8773",
            "fax_number": "909-469-5228"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "795 E. SECOND STREET",
            "address_2": "SUITE 2",
            "city": "POMONA",
            "state": "CA",
            "postal_code": "917662007",
            "telephone_number": "909-706-3899",
            "fax_number": "909-469-8640"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PHAM",
        "first_name": "CHRISTINE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-04-02",
        "last_updated": "2016-11-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "OPT15386TLG",
            "primary": true
        },
        {
            "code": "152WC0802X",
            "taxonomy_group": "",
            "desc": "Optometrist, Corneal and Contact Management",
            "state": "CA",
            "license": "15386TLG",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN SO CAL",
            "identifier": "CB243539",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Pomona, CA

Sources for this page

Verify at the official NPI Registry.