Individual provider Active NPI

Doan Trang Kwak, OD

  • Optometrist
  • Philadelphia, PA
National Provider Identifier
1093060444
Registry record updated Mar 19, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
OEG002671 Issued in PA
Practice address
1200 W Godfrey Ave
Philadelphia, PA 19141-3323
Phone
(215) 276-6000
Fax
(215) 276-1329
NPI assigned
Jul 20, 2012
Last updated
Mar 19, 2018By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 19, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X OEG002671 PA Primary

Addresses

Primary practice location

1200 W Godfrey Ave
Philadelphia, PA 19141-3323

Mailing address

200 Mall Blvd
King of Prussia, PA 19406-2902
Phone (610) 337-1580

Other practice location 1

3300 Henry Ave Ste 104
Philadelphia, PA 19129-1121
Phone (215) 276-6000

Other practice location 2

200 Mall Blvd
King Of Prussia, PA 19406-2902
Phone (610) 337-1580

Other practice location 3

7630 Germantown Ave Ste 4
Philadelphia, PA 19118-3529
Phone (215) 276-6000

Other identifiers 1

IdentifierTypeStateIssuer
OEG002671OtherPALICENSE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
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
I20120820000530 PA Practitioner - Optometry 6002062494 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Illinois College of Optometry at Chicago, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Drexel UniversityGroup PAC ID 5496664740, 80 clinicians

Practice addresses (Care Compare)

1200 W Godfrey Ave
Philadelphia, PA 19141-3323
Phone (215) 276-6000

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Salus University Hearing Vision Balance Clinic Optometrist CurrentSince Oct 16, 2017 Accepting new patients
Drexel University CurrentSince Dec 23, 2024 Accepting new patients
Drexel University Current Accepting new patients
Drexel University CurrentSince Dec 23, 2024 Accepting new patients
Drexel University Optometrist CurrentSince Oct 16, 2017 Accepting new patients
Pennsylvania College of Optometry Optometrist Past Accepting new patients

Locations

1200 W Godfrey Ave
Philadelphia, PA 19141
Phone (215) 276-6000

7630 Germantown Ave
Ste 4
Philadelphia, PA 19118
Phone (215) 276-6000

1427 Vine St
Fl 2
Philadelphia, PA 19102
Phone (215) 762-2530

1427 Vine St
Fl 8
Philadelphia, PA 19102
Phone (215) 762-6660

3300 Henry Ave
Ste 104
Philadelphia, PA 19129
Phone (215) 276-1329

Interoperability endpoints

  • Direct secure messaging: doantrang.kwak.p1@direct.salusuhealth.nextgenshare.com
  • FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/

Organizations & group practices 6

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": "1342742400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521417600000",
    "number": "1093060444",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 MALL BLVD",
            "city": "KING OF PRUSSIA",
            "state": "PA",
            "postal_code": "194062902",
            "telephone_number": "610-337-1580",
            "fax_number": "610-337-2133"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 W GODFREY AVE",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191413323",
            "telephone_number": "215-276-6000",
            "fax_number": "215-276-1329"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3300 Henry Ave Ste 104",
            "address_purpose": "LOCATION",
            "city": "Philadelphia",
            "state": "PA",
            "postal_code": "191291121",
            "country_code": "US",
            "telephone_number": "215-276-6000",
            "fax_number": "215-276-1329",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "200 Mall Blvd",
            "address_purpose": "LOCATION",
            "city": "King Of Prussia",
            "state": "PA",
            "postal_code": "194062902",
            "country_code": "US",
            "telephone_number": "610-337-1580",
            "fax_number": "610-337-2133",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "7630 Germantown Ave Ste 4",
            "address_purpose": "LOCATION",
            "city": "Philadelphia",
            "state": "PA",
            "postal_code": "191183529",
            "country_code": "US",
            "telephone_number": "215-276-6000",
            "fax_number": "215-276-1329",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KWAK",
        "first_name": "DOAN TRANG",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-07-20",
        "last_updated": "2018-03-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "PA",
            "license": "OEG002671",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "OEG002671",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.