Jack Chia Shea, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

11538TPL Issued in CA

Practice address

2200 Harbor Blvd
Ste D130
Costa Mesa, CA 92627

Phone

(949) 642-7882

Fax

(949) 642-7792

NPI assigned

Aug 2, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: jack.shea@uprisedirect.com
• FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/

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.

• New Foundation Medical Inc.

  • Multi-Specialty Clinic/Center
  • Santa Ana, CA
  • NPI 1689023582

  Optometrist

  Medicare reassignment NPD
• Access Community Health Center

  • Federally Qualified Health Center (FQHC)
  • Santa Ana, CA
  • NPI 1184234726
  NPD (past)

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

{
    "created_epoch": "1154476800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1174530877",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2200 HARBOR BLVD",
            "address_2": "STE D130",
            "city": "COSTA MESA",
            "state": "CA",
            "postal_code": "92627",
            "telephone_number": "949-642-7882",
            "fax_number": "949-642-7792"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2200 HARBOR BLVD",
            "address_2": "STE D130",
            "city": "COSTA MESA",
            "state": "CA",
            "postal_code": "92627",
            "telephone_number": "949-642-7882",
            "fax_number": "949-642-7792"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHEA",
        "first_name": "JACK",
        "middle_name": "CHIA",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-02",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "11538TPL",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Share Our Selves Corporation
• Share Our Selves Corporation
• Elham Sharif, MSPO, CPO, CPED
• Pravin Shaw, D.O.
• Shea Optometric Corporation
• Deshna Shekar
• Taylor Shelton
• Sue Shepard, MFT
• Corey Andrew Shepherd Tsabetsaye
• Valerie Christine Sheppard, M.D.

• Optometrist in Costa Mesa, CA
• Providers in Costa Mesa, CA by specialty
• Optometrist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.