Active NPI
Johnny T. Wu, O.D.
- Optometrist
- San Diego, CA
National Provider Identifier
1174661979
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 12469T
- Practice address
- 12070 Carmel Mountain Rd Ste 292
San Diego, CA 92128-4651 - Phone
- (858) 676-3926
- Fax
- (858) 676-3927
- NPI assigned
- Feb 2, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 12469T | CA | Primary |
Addresses
Primary practice location
12070 Carmel Mountain Rd Ste 292
San Diego, CA 92128-4651
Mailing address
12070 Carmel Mountain Rd Ste 292
San Diego, CA 92128-4651
Phone (858) 676-3926
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 12469T | CA | MD | Optometrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Total Vision PC | Optometrist | Past | Accepting new patients |
| John C Pack, O.D. and Beverly Bianes, O.D. Inc | Optometrist | 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 and National Provider Directory roles.
-
- Optometrist
- Chula Vista, CA
- NPI 1255396461
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1170374400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1174661979",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12070 CARMEL MOUNTAIN RD STE 292",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921284651",
"telephone_number": "858-676-3926",
"fax_number": "858-676-3927"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12070 CARMEL MOUNTAIN RD STE 292",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921284651",
"telephone_number": "858-676-3926",
"fax_number": "858-676-3927"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WU",
"first_name": "JOHNNY",
"middle_name": "T.",
"name_prefix": "Dr.",
"credential": "O.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-02-02",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "CA",
"license": "12469T",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Diego, CA
Sources for this page
- 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.