Individual provider Active NPI

Jessa Marie Vankleeck, OD

  • Optometrist
  • Newport Beach, CA
National Provider Identifier
1255991840
Registry record updated Mar 19, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
OPT34433TLG Issued in CA
Practice address
522 Old Newport Blvd
Newport Beach, CA 92663-4212
Phone
(949) 650-9060
NPI assigned
Jun 17, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 19, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X TUV008978 NY
Optometrist 152W00000X OPT34433TLG CA Primary

Addresses

Primary practice location

522 Old Newport Blvd
Newport Beach, CA 92663-4212

Mailing address

522 Old Newport Blvd
Newport Beach, CA 92663-4212
Phone (949) 650-9060

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX, CA2 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

Enrollment IDStateProvider typePAC IDDetails
I20201216002890 TX Practitioner - Optometry 7416369343 Reassigns benefits to 1 organization
I20221108003570 CA Practitioner - Optometry 7416369343 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
State University of New York - State College Optometry, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Old Newport Optometric AssociatesGroup PAC ID 1254680903, 2 clinicians

Practice addresses (Care Compare)

522 Old Newport Blvd
Newport Beach, CA 92663-4212
Phone (949) 650-9060

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
34433CAMDMarriage & Family Therapist
OPT34433TLGCAMDOptometrist
TUV008978NYMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Bristol Bay Area Health Corporation Current Accepting new patients
Bristol Bay Area Health Corporation Current Accepting new patients
Bristol Bay Area Health Corporation Current Accepting new patients
Bristol Bay Area Health Corporation Current Accepting new patients
Bristol Bay Area Health Corporation Current Accepting new patients
Bristol Bay Area Health Corporation CurrentSince Nov 10, 2020 Accepting new patients
Bristol Bay Area Health Corporation Current Accepting new patients
Bristol Bay Area Health Corporation Current Accepting new patients
Old Newport Optometric Associates Optometrist CurrentSince Jun 20, 2022 Accepting new patients
Bristol Bay Area Health Corportion Current Accepting new patients
Bristol Bay Area Health Corportation Current Accepting new patients
Bristol Bay Area Health Corporation Current Accepting new patients
Bristol Bay Area Health Corporation CurrentSince Nov 10, 2020 Accepting new patients
Bristol Bay Area Health Corporation Current Accepting new patients
Bristol Bay Area Health Corporation Current Accepting new patients
Bristol Bay Area Health Corporation Current Accepting new patients
Bristol Bay Area Health Corporation Current Accepting new patients
Bristol Bay Area Health Corporation Current Accepting new patients
Bristol Bay Area Health Corporation Current Accepting new patients
Bristol Bay Area Health Corportion Current Accepting new patients
Bristol Bay Area Health Corporation Current Accepting new patients
Coastal Eye Care, a Medical Corporation PastSince Mar 22, 2020 Accepting new patients
Luxottica of America Inc. PastSince Aug 11, 2019 Accepting new patients
Luxottica of America Inc Past Accepting new patients

Locations

522 Old Newport Blvd
Newport Beach, CA 92663
Phone (949) 644-1112

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/16772/brand/1/csg/1/fhir/r4

Organizations & group practices 24

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.

View all 24

NPI Registry JSON

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

{
    "created_epoch": "1560729600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1584576000000",
    "number": "1255991840",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "522 OLD NEWPORT BLVD",
            "city": "NEWPORT BEACH",
            "state": "CA",
            "postal_code": "926634212",
            "telephone_number": "949-650-9060"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "522 OLD NEWPORT BLVD",
            "city": "NEWPORT BEACH",
            "state": "CA",
            "postal_code": "926634212",
            "telephone_number": "949-650-9060"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VANKLEECK",
        "first_name": "JESSA",
        "middle_name": "MARIE",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-06-17",
        "last_updated": "2020-03-19",
        "certification_date": "2020-03-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NY",
            "license": "TUV008978",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "OPT34433TLG",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Newport Beach, CA

Sources for this page

Verify at the official NPI Registry.