Individual provider Active NPI

Joanne C. Gwo, O.D.

  • Optometrist
  • South San Francisco, CA
National Provider Identifier
1083900336
Registry record updated Aug 24, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
OPT14201TLG Issued in CA
Practice address
1600 El Camino Real
Optometry Department
South San Francisco, CA 94080-1206
Phone
(650) 992-5881
NPI assigned
Jun 24, 2011
Last updated
Aug 24, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 24, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X OPT14201TLG CA Primary

Addresses

Primary practice location

1600 El Camino Real
Optometry Department
South San Francisco, CA 94080-1206

Mailing address

2010 El Camino Real # 336
Santa Clara, CA 95050-4051

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
I20111208000335 CA Practitioner - Optometry 6507031234 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
OPT14201TLGCAMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Crest Optometry, Inc Optometrist CurrentSince Apr 4, 2019 Accepting new patients
Mark S Ichikawa, OD Optometrist Past Accepting new patients
Cindy H. Tran, OD, a Professional Optometric Corporation Optometrist PastSince May 1, 2014 Accepting new patients

Locations

173 N Morrison Ave
Ste B
San Jose, CA 95126
Phone (408) 372-7647

173 N Morrison Ave
Ste E
San Jose, CA 95126
Phone (408) 372-7647

Interoperability endpoints

  • Direct secure messaging: joanne.gwo@49412312072196.direct.elationemr.com

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, 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": "1308873600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1661299200000",
    "number": "1083900336",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2010 EL CAMINO REAL # 336",
            "city": "SANTA CLARA",
            "state": "CA",
            "postal_code": "950504051"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1600 EL CAMINO REAL",
            "address_2": "OPTOMETRY DEPARTMENT",
            "city": "SOUTH SAN FRANCISCO",
            "state": "CA",
            "postal_code": "940801206",
            "telephone_number": "650-992-5881"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GWO",
        "first_name": "JOANNE",
        "middle_name": "C.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-06-24",
        "last_updated": "2022-08-24",
        "certification_date": "2022-08-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "OPT14201TLG",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in South San Francisco, CA

Sources for this page

Verify at the official NPI Registry.