Individual provider Active NPI

Jina Yoo, OD

  • Optometrist
  • Bronx, NY
National Provider Identifier
1104652668
Registry record updated Sep 17, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
011029 Issued in NY
Practice address
731 Lydig Ave
Bronx, NY 10462-2103
Phone
(718) 829-2160
Fax
(718) 829-9502
NPI assigned
Sep 11, 2024
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 17, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 011029 NY Primary

Addresses

Primary practice location

731 Lydig Ave
Bronx, NY 10462-2103

Mailing address

731 Lydig Ave
Bronx, NY 10462-2103
Phone (347) 455-1601

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
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
I20241125001266 NY Practitioner - Optometry 1052846201 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
State University of New York - State College Optometry, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Pelham Parkway Vision Center IncGroup PAC ID 6305938218, 4 clinicians

Practice addresses (Care Compare)

731 Lydig Ave
Bronx, NY 10462-2103
Phone (718) 829-2160

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Pelham Parkway Vision Center Inc CurrentSince Sep 12, 2024 Accepting new patients

Locations

731 Lydig Ave
Bronx, NY 10462
Phone (718) 829-2160

Organizations & group practices 1

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": "1726012800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1726531200000",
    "number": "1104652668",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "731 LYDIG AVE",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104622103",
            "telephone_number": "347-455-1601"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "731 LYDIG AVE",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104622103",
            "telephone_number": "718-829-2160",
            "fax_number": "718-829-9502"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "YOO",
        "first_name": "JINA",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-09-11",
        "last_updated": "2024-09-17",
        "certification_date": "2024-09-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NY",
            "license": "011029",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bronx, NY

Sources for this page

Verify at the official NPI Registry.