Individual provider Active NPI

Jamie Anne Pineda Llanera, OD

  • Optometrist
  • Fresno, CA
National Provider Identifier
1104470897
Registry record updated Jul 30, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
34279 Issued in CA
Practice address
2615 E Clinton Ave
Fresno, CA 93703-2223
Phone
(559) 255-6100
NPI assigned
Jul 30, 2019
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 30, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 34279 CA Primary

Addresses

Primary practice location

2615 E Clinton Ave
Fresno, CA 93703-2223

Mailing address

2754 Seadrift LN
Hayward, CA 94545-1366
Phone (510) 329-3137

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
I20200923001518 CA Practitioner - Optometry 8325467459 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Dr Angela Wong IncGroup PAC ID 4880071695, 2 clinicians

Practice addresses (Care Compare)

34724 Alvarado Niles Rd
Union City, CA 94587-4502
Phone (510) 489-5510

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Dr. Angela Wong, Inc Optometrist CurrentSince Apr 12, 2022 Accepting new patients
Affinity Medical Group PastSince Sep 2, 2020 Accepting new patients
Gary M. Louie O.D. Inc. Optometrist PastSince Apr 12, 2022 Accepting new patients

Locations

34724 Alvarado Niles Rd
Union City, CA 94587
Phone (510) 489-5510

Organizations & group practices 4

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": "1564444800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1564444800000",
    "number": "1104470897",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2754 SEADRIFT LN",
            "city": "HAYWARD",
            "state": "CA",
            "postal_code": "945451366",
            "telephone_number": "510-329-3137"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2615 E CLINTON AVE",
            "city": "FRESNO",
            "state": "CA",
            "postal_code": "937032223",
            "telephone_number": "559-255-6100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LLANERA",
        "first_name": "JAMIE ANNE",
        "middle_name": "PINEDA",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-07-30",
        "last_updated": "2019-07-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "34279",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fresno, CA

Sources for this page

Verify at the official NPI Registry.