Matthew M. Enos, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

14879 TLG Issued in CA

Practice address

8190 Mango Ave
Fontana, CA 92335-3610

Phone

(909) 350-2020

NPI assigned

Jul 15, 2013

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Electronic endpoints 1

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

Specialty

Optometry

Education

Other, 2009

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Southern California Permanente Medical GroupGroup PAC ID 6002729175, 11,250 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Southern California Permanente Medical Group

  • Health Maintenance Organization
  • Riverside, CA
  • NPI 1316979834
  Medicare reassignment Care Compare group NPD
• Orinda Optometry Group, Inc

  • Optometrist
  • Orinda, CA
  • NPI 1487843652
  Medicare reassignment NPD
• Southern California Permanente Medical Group

  • Health Maintenance Organization
  • Santa Clarita, CA
  • NPI 1316409410
  NPD
• Southern California Permanente Medical Group

  • Health Maintenance Organization
  • Fontana, CA
  • NPI 1689606196
  NPD
• Andrew Calman

  • Specialist
  • San Francisco, CA
  • NPI 1275720534
  NPD (past)
• Loran Bruce Mebine

  • Optometrist
  • San Francisco, CA
  • NPI 1275694531
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1373846400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1635724800000",
    "number": "1134560477",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8190 MANGO AVE",
            "city": "FONTANA",
            "state": "CA",
            "postal_code": "923353610",
            "telephone_number": "909-350-2020"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8190 MANGO AVE",
            "city": "FONTANA",
            "state": "CA",
            "postal_code": "923353610",
            "telephone_number": "909-350-2020"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3201 Mission St",
            "address_purpose": "LOCATION",
            "city": "San Francisco",
            "state": "CA",
            "postal_code": "941105006",
            "country_code": "US",
            "telephone_number": "415-648-4600",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3201 Mission St",
            "address_purpose": "LOCATION",
            "city": "San Francisco",
            "state": "CA",
            "postal_code": "941105006",
            "country_code": "US",
            "telephone_number": "415-648-4600",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ENOS",
        "first_name": "MATTHEW",
        "middle_name": "M.",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2013-07-15",
        "last_updated": "2021-11-01",
        "certification_date": "2021-11-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NY",
            "license": "TUV007985",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "14879 TLG",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq",
            "affiliation": "Y",
            "endpointDescription": "Carequality",
            "affiliationName": "Southern California Permanente Medical Group",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "9961 Sierra Ave",
            "city": "Fontana",
            "state": "CA",
            "country_code": "US",
            "postal_code": "923356720",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Jonathan Tyler Enriquez, DC
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• Optometrist in Fontana, CA
• Providers in Fontana, CA by specialty
• Optometrist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 1, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.