Elaine Pyng Oetomo

Primary specialty

OptometristTaxonomy code 152W00000X

License

OPT-002345 Issued in AZ

Practice address

9340 W Northern Ave Ste 120
Glendale, AZ 85305-1148

Phone

(602) 794-1608

NPI assigned

Jun 12, 2019

Sex

Female

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 AZ, TX2 enrollments

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 2

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: dr.elaine.oetomo@direct.eyecare-partners.com
• FHIR API: https://app.meldrx.com/api/fhir/ecp_cecaz

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.

• Nationwide Optometry P.C.

  • Optometrist
  • Tempe, AZ
  • NPI 1326472945
  Medicare reassignment NPD
• Optical Expressions PLLC

  • Optometrist
  • Phoenix, AZ
  • NPI 1013141399
  Medicare reassignment NPD
• Salt River Pima-Maricopa Indian Community

  • Community Health Clinic/Center
  • Scottsdale, AZ
  • NPI 1942668991

  TX

  Medicare reassignment NPD
• Serena Shao OD PLLC

  • Optometrist
  • Scottsdale, AZ
  • NPI 1174293898
  Medicare reassignment NPD
• Nationwide Optometry P.C.

  • Optometrist
  • Sun City West, AZ
  • NPI 1427374347
  NPD
• Salt River Pima-Maricopa Indian Community

  • Community Health Clinic/Center
  • Scottsdale, AZ
  • NPI 1538583125
  NPD
• National Vision Inc

  • Optician
  • Glendale, AZ
  • NPI 1932677713
  NPD (past)
• Emergency Medical & Surgical Specialists of Colorado LLC

  • Critical Access Hospital
  • Denver, CO
  • NPI 1144669102
  NPD (past)

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

{
    "created_epoch": "1560297600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1706054400000",
    "number": "1235798174",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "39 DEER TRAK",
            "city": "IRVINE",
            "state": "CA",
            "postal_code": "926188812"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9340 W NORTHERN AVE STE 120",
            "city": "GLENDALE",
            "state": "AZ",
            "postal_code": "853051148",
            "telephone_number": "602-794-1608"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "8404 E Shea Blvd # 105",
            "address_purpose": "LOCATION",
            "city": "Scottsdale",
            "state": "AZ",
            "postal_code": "852606658",
            "country_code": "US",
            "telephone_number": "480-483-0711",
            "fax_number": "480-483-8535",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "OETOMO",
        "first_name": "ELAINE",
        "middle_name": "PYNG",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-06-12",
        "last_updated": "2024-01-24",
        "certification_date": "2024-01-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "AZ",
            "license": "OPT-002345",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Oculoplastic Consultants of Arizona P C
• Emily Megan Odogui-Cruz, RBT
• Rose Odum, M.A. CCC-SLP
• Mary Jo Oechslin
• Christine M Oehler, MD
• Elizabeth Marie Ogah
• Ipuole Paulinus Ogar, MD
• Virginia Danette Ogunsile, RN
• Eugene Oh, MD
• Christina Ohearn, PA-C

• Optometrist in Glendale, AZ
• Providers in Glendale, AZ by specialty
• Optometrist in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 24, 2024; 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.