Individual provider Active NPI

Vivian Look

  • Optometrist
  • San Jose, CA
National Provider Identifier
1124672399
Registry record updated Jan 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
34268TLG Issued in CA
Practice address
1035 S de Anza Blvd Ste 1
San Jose, CA 95129-2772
Phone
(408) 446-5533
NPI assigned
Jul 26, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 21, 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 34268TLG CA Primary

Addresses

Primary practice location

1035 S de Anza Blvd Ste 1
San Jose, CA 95129-2772

Mailing address

1035 S de Anza Blvd Ste 1
San Jose, CA 95129-2772
Phone (408) 446-5533

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
I20190910001534 CA Practitioner - Optometry 4880923234 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
34268TLGCAMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
De Anza Vision Center a Professional Optometric Corp Optometrist CurrentSince Jan 26, 2022 Accepting new patients
Peter W Ross OD & Larry K Wan OD Inc Optometrist CurrentSince Feb 1, 2021 Accepting new patients
Loran Bruce Mebine Optometrist PastSince Jul 16, 2019 Accepting new patients

Locations

338 E Hamilton Ave
Campbell, CA 95008
Phone (408) 866-2020

1035 S De Anza Blvd
Ste 1
San Jose, CA 95129
Phone (408) 446-5533

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": "1564099200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1642723200000",
    "number": "1124672399",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1035 S DE ANZA BLVD STE 1",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951292772",
            "telephone_number": "408-446-5533"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1035 S DE ANZA BLVD STE 1",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951292772",
            "telephone_number": "408-446-5533"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LOOK",
        "first_name": "VIVIAN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-07-26",
        "last_updated": "2022-01-21",
        "certification_date": "2022-01-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "34268TLG",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Jose, CA

Sources for this page

Verify at the official NPI Registry.