Active NPI
Chan Woo Lee, O.D.
- Optometrist
- Corona, CA
National Provider Identifier
1326038993
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 12516TPA
- Practice address
- 2790 Cabot Drive
Suite 135
Corona, CA 92883 - Phone
- (951) 277-2774
- Fax
- (951) 271-9754
- NPI assigned
- Oct 25, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 12516TPA | CA | Primary |
Addresses
Primary practice location
2790 Cabot Drive
Suite 135
Corona, CA 92883
Mailing address
2790 Cabot Drive
Suite 135
Corona, CA 92883
Phone (951) 277-2774
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 8073436 | Medicaid | CA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Optometry
- Education
- Southern California College of Optometry, 1996
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
2790 Cabot Dr
Corona, CA 92883-0862
Phone (951) 277-2774
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 12516TPA | CA | MD | Optometrist |
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 and National Provider Directory roles.
-
- Optometrist
- Corona, CA
- NPI 1659575736
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1130198400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1393545600000",
"number": "1326038993",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2790 CABOT DRIVE",
"address_2": "SUITE 135",
"city": "CORONA",
"state": "CA",
"postal_code": "92883",
"telephone_number": "951-277-2774",
"fax_number": "951-271-9754"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2790 CABOT DRIVE",
"address_2": "SUITE 135",
"city": "CORONA",
"state": "CA",
"postal_code": "92883",
"telephone_number": "951-277-2774",
"fax_number": "951-271-9754"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LEE",
"first_name": "CHAN",
"middle_name": "WOO",
"name_prefix": "Dr.",
"credential": "O.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-10-25",
"last_updated": "2014-02-28",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "CA",
"license": "12516TPA",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "8073436",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Corona, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 28, 2014; 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.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.