Individual provider Active NPI

Kristen Ying Oda, OD

  • Optometrist
  • San Jose, CA
National Provider Identifier
1174048698
Registry record updated Aug 5, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
33814LTG Issued in CA
Practice address
214 Jackson St
San Jose, CA 95112-3201
Phone
(408) 293-3730
NPI assigned
Aug 5, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 5, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 33814LTG CA Primary

Addresses

Primary practice location

214 Jackson St
San Jose, CA 95112-3201

Mailing address

1122 Kovanda Way
Milpitas, CA 95035-3130
Phone (408) 420-6925

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
I20170911000481 CA Practitioner - Optometry 5395018568 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
University of California - School of Optometry, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Fifth Optometric Care of CaliforniaGroup PAC ID 4284096298, 22 clinicians

Practice addresses (Care Compare)

214 Jackson St
San Jose, CA 95112-3201
Phone (408) 293-3730

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
33814CAMDDentist
33814LTGCAMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Fifth Optometric Care of California Optometrist CurrentSince Jul 11, 2023 Accepting new patients
Fifth Optometric Care of California Optometrist Current Accepting new patients
Shinmori Optometry, Inc. Optometrist CurrentSince Aug 24, 2017 Accepting new patients
Fifth Optometric Care of California Optometrist CurrentSince Jul 11, 2023 Accepting new patients

Locations

3333 Quality Dr
Rncho Cordova, CA 95670
Phone (704) 712-0564

214 Jackson St
San Jose, CA 95112
Phone (408) 293-3730

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": "1501891200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1501891200000",
    "number": "1174048698",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1122 KOVANDA WAY",
            "city": "MILPITAS",
            "state": "CA",
            "postal_code": "950353130",
            "telephone_number": "408-420-6925"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "214 JACKSON ST",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951123201",
            "telephone_number": "408-293-3730"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ODA",
        "first_name": "KRISTEN",
        "middle_name": "YING",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-08-05",
        "last_updated": "2017-08-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "33814LTG",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Jose, CA

Sources for this page

Verify at the official NPI Registry.