Individual provider Active NPI

Michelle Xiaoqi Mo, O.D.

  • Optometrist
  • Union City, CA
National Provider Identifier
1164505814
Registry record updated Jun 8, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
11925T Issued in CA
Practice address
3904 Smith St
Union City, CA 94587-2616
Phone
(510) 270-5634
Fax
(510) 298-5692
NPI assigned
Oct 23, 2006
Last updated
Jun 8, 2016By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 8, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 11925T CA Primary

Addresses

Primary practice location

3904 Smith St
Union City, CA 94587-2616

Mailing address

38052 Conrad St
Fremont, CA 94536-3924
Phone (510) 331-6466

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
I20070111000402 CA Practitioner - Optometry 5799785945 Practice locations: Fremont, CA; Union City, CA

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
University of California - School of Optometry, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

3904 Smith St
Union City, CA 94587-2616
Phone (510) 270-5634

39656 Mission Blvd
Fremont, CA 94539-3000
Phone (510) 270-5634

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
11925TCAMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Usv Optical Inc Optometrist Past Accepting new patients
Usv Optical Inc. Past Accepting new patients

Organizations & group practices 2

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": "1161561600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1465344000000",
    "number": "1164505814",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "38052 CONRAD ST",
            "city": "FREMONT",
            "state": "CA",
            "postal_code": "945363924",
            "telephone_number": "510-331-6466",
            "fax_number": "510-713-8510"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3904 SMITH ST",
            "city": "UNION CITY",
            "state": "CA",
            "postal_code": "945872616",
            "telephone_number": "510-270-5634",
            "fax_number": "510-298-5692"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MO",
        "first_name": "MICHELLE",
        "middle_name": "XIAOQI",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-10-23",
        "last_updated": "2016-06-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "11925T",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Union City, CA

Sources for this page

Verify at the official NPI Registry.