Individual provider Active NPI

Andrew G Chong, O.D.

  • Optometrist
  • La Puente, CA
National Provider Identifier
1073676029
Registry record updated Jul 9, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
CA7758 Issued in CA
Practice address
1641 N Hacienda Blvd
La Puente, CA 91744-1137
Phone
(626) 918-1407
Fax
(626) 918-2069
NPI assigned
Dec 19, 2006
Last updated
Jul 9, 2007By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 9, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X CA7758 CA Primary

Addresses

Primary practice location

1641 N Hacienda Blvd
La Puente, CA 91744-1137

Mailing address

1641 N Hacienda Blvd
La Puente, CA 91744-1137
Phone (626) 918-1407

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
I20090115000235 CA Practitioner - Optometry 7911060066 Reassigns benefits to 1 organization
Practice locations: Chino, CA; La Puente, CA

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
CA7758CAMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Chino Optometry Center Optometrist CurrentSince Jul 28, 2015 Accepting new patients
Andrew G Chong, O.D. Optometrist PastSince Jan 1, 1990 Accepting new patients

Locations

11640 Central Ave
Chino, CA 91710
Phone (909) 627-7363

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1166486400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1073676029",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1641 N HACIENDA BLVD",
            "city": "LA PUENTE",
            "state": "CA",
            "postal_code": "917441137",
            "telephone_number": "626-918-1407",
            "fax_number": "626-918-2069"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1641 N HACIENDA BLVD",
            "city": "LA PUENTE",
            "state": "CA",
            "postal_code": "917441137",
            "telephone_number": "626-918-1407",
            "fax_number": "626-918-2069"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHONG",
        "first_name": "ANDREW",
        "middle_name": "G",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-12-19",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "CA7758",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in La Puente, CA

Sources for this page

Verify at the official NPI Registry.