NPIMap

Organization Active NPI

Michael Duong, OD

  • Optometrist
  • San Ramon, CA
National Provider Identifier
1316468176
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
14540TLG Issued in CA
Legal business name
MICHAEL DUONG, OD
Practice address
2551 San Ramon Valley Blvd Ste 101
San Ramon, CA 94583-1661
Phone
(925) 743-1222
Fax
(925) 743-1221
NPI assigned
Jul 3, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Authorized official

Name
Lyndsy Faulkner, CPOC
Title
Accounts Manager
Phone
(925) 743-1222

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193200000X MULTI-SPECIALTY GROUP 152W00000X 14540TLG CA Primary
OptometristGroup: 193200000X MULTI-SPECIALTY GROUP 152W00000X 5287T CA
Corneal and Contact Management OptometristGroup: 193200000X MULTI-SPECIALTY GROUP 152WC0802X 14540TLG CA
Pediatric OptometristGroup: 193200000X MULTI-SPECIALTY GROUP 152WP0200X 14540TLG CA

Addresses

Primary practice location

2551 San Ramon Valley Blvd Ste 101
San Ramon, CA 94583-1661

Mailing address

2551 San Ramon Valley Blvd Ste 101
San Ramon, CA 94583-1661
Phone (925) 743-1222

Other names 1

  • Optometric Center and Eyewear Galleria Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20180503002807 CA Part B Supplier - Clinic/Group Practice 2466725056 Receives reassigned benefits from 2 practitioners
Practice locations: San Ramon, CA

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

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

NPI Registry JSON

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

{
    "created_epoch": "1499040000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1316468176",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2551 SAN RAMON VALLEY BLVD STE 101",
            "city": "SAN RAMON",
            "state": "CA",
            "postal_code": "945831661",
            "telephone_number": "925-743-1222",
            "fax_number": "925-743-1221"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2551 SAN RAMON VALLEY BLVD STE 101",
            "city": "SAN RAMON",
            "state": "CA",
            "postal_code": "945831661",
            "telephone_number": "925-743-1222",
            "fax_number": "925-743-1221"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MICHAEL DUONG, OD",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-07-03",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "FAULKNER",
        "authorized_official_first_name": "LYNDSY",
        "authorized_official_title_or_position": "ACCOUNTS MANAGER",
        "authorized_official_telephone_number": "925-743-1222",
        "authorized_official_credential": "CPOC"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": "CA",
            "license": "14540TLG",
            "primary": true
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": "CA",
            "license": "5287T",
            "primary": false
        },
        {
            "code": "152WC0802X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist, Corneal and Contact Management",
            "state": "CA",
            "license": "14540TLG",
            "primary": false
        },
        {
            "code": "152WP0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist, Pediatrics",
            "state": "CA",
            "license": "14540TLG",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Optometric Center and Eyewear Galleria",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Optometric Center and Eyewear Galleria",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in San Ramon, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.