Individual provider Active NPI

Calvin Sun, OD

  • Optometrist
  • La Quinta, CA
National Provider Identifier
1255176731
Registry record updated Jun 27, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
35768 Issued in CA
Practice address
46660 Washington St Ste 3
La Quinta, CA 92253-2451
Phone
(760) 564-9944
NPI assigned
Jun 27, 2024
Last updated
Jun 27, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 27, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 35768 CA Primary

Addresses

Primary practice location

46660 Washington St Ste 3
La Quinta, CA 92253-2451

Mailing address

18812 Belshire Ave
Cerritos, CA 90703-8410
Phone (619) 430-0577

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: No
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240809001907 CA Practitioner - Optometry 5496293391 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Illinois College of Optometry at Chicago, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Dr Stefie Ribeiro O D Prof CorpGroup PAC ID 4082970769, 2 clinicians

Practice addresses (Care Compare)

46660 Washington St
Suite 3
La Quinta, CA 92253-2451
Phone (760) 564-9944

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
35768CAMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Dr Stefie Ribeiro O D Prof Corp Optometrist CurrentSince Aug 2, 2024 Accepting new patients

Locations

46660 Washington St
Ste 3
La Quinta, CA 92253
Phone (760) 564-2113

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1719446400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1719446400000",
    "number": "1255176731",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18812 BELSHIRE AVE",
            "city": "CERRITOS",
            "state": "CA",
            "postal_code": "907038410",
            "telephone_number": "619-430-0577"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "46660 WASHINGTON ST STE 3",
            "city": "LA QUINTA",
            "state": "CA",
            "postal_code": "922532451",
            "telephone_number": "760-564-9944"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SUN",
        "first_name": "CALVIN",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-06-27",
        "last_updated": "2024-06-27",
        "certification_date": "2024-06-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "35768",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in La Quinta, CA

Sources for this page

Verify at the official NPI Registry.