Individual provider Active NPI

Jeffrey T Kubo, O.D.

  • Optometrist
  • Thousand Oaks, CA
National Provider Identifier
1215071824
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
10254 Issued in CA
Practice address
280 W Hillcrest Dr
Thousand Oaks, CA 91360-4210
Phone
(805) 497-3594
NPI assigned
Feb 16, 2007
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 10254 CA Primary

Addresses

Primary practice location

280 W Hillcrest Dr
Thousand Oaks, CA 91360-4210

Mailing address

466 Novara Way
Oak Park, CA 91377-5556
Phone (805) 497-3594

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
I20220118001524 CA Practitioner - Optometry 9638561905 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Southern California College of Optometry, 1993
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

223 E Thousand Oaks Blvd
Suite 417
Thousand Oaks, CA 91360-5840
Phone (805) 379-9912

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
10254CAMDPsychiatry Physician

Practice roles

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

Organizations & group practices 3

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": "1171584000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1215071824",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "466 NOVARA WAY",
            "city": "OAK PARK",
            "state": "CA",
            "postal_code": "913775556",
            "telephone_number": "805-497-3594"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "280 W HILLCREST DR",
            "city": "THOUSAND OAKS",
            "state": "CA",
            "postal_code": "913604210",
            "telephone_number": "805-497-3594"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KUBO",
        "first_name": "JEFFREY",
        "middle_name": "T",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-02-16",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "10254",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Thousand Oaks, CA

Sources for this page

Verify at the official NPI Registry.