Eye Boutique Optometry Inc

Primary specialty

OptometristTaxonomy code 152W00000X

License

7882TPA Issued in CA

Legal business name

EYE BOUTIQUE OPTOMETRY INC

Practice address

2908 El Camino Real Ste 120
Santa Clara, CA 95051-2944

Phone

(408) 984-2020

Fax

(408) 984-2016

NPI assigned

May 4, 2012

Organization subpart

No

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

Authorized official

Name

Somi OhNPI 1629117940

Title

Owner

Phone

(408) 984-2020

Specialties & licenses 1

Addresses

Other names 1

• Somi Oh, O.D. Other name

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Somi Oh, O.D.

  • Optometrist
  • Santa Clara, CA
  • NPI 1629117940
  Medicare reassignment Authorized official
• Hungsun Song Chung, O.D.

  • Optometrist
  • Santa Clara, CA
  • NPI 1366585028
  NPD
• Mu Zhang, D.O.

  • Optometrist
  • Sunnyvale, CA
  • NPI 1871895524
  NPD (past)

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

{
    "created_epoch": "1336089600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1676937600000",
    "number": "1215296637",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2908 EL CAMINO REAL STE 120",
            "city": "SANTA CLARA",
            "state": "CA",
            "postal_code": "950512944",
            "telephone_number": "408-984-2020",
            "fax_number": "408-984-2016"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2908 EL CAMINO REAL STE 120",
            "city": "SANTA CLARA",
            "state": "CA",
            "postal_code": "950512944",
            "telephone_number": "408-984-2020",
            "fax_number": "408-984-2016"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EYE BOUTIQUE OPTOMETRY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-05-04",
        "last_updated": "2023-02-21",
        "certification_date": "2023-02-21",
        "status": "A",
        "authorized_official_last_name": "OH",
        "authorized_official_first_name": "SOMI",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "408-984-2020"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "CA",
            "license": "7882TPA",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Somi Oh, O.D.",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Optometrist in Santa Clara, CA
• Providers in Santa Clara, CA by specialty
• Optometrist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 21, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.