Individual provider Active NPI

Annessa Du

  • Optometrist
  • Loma Linda, CA
National Provider Identifier
1366008633
Registry record updated Jan 9, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
34372 Issued in CA
Practice address
11346 Mountain View Ave Ste B
Loma Linda, CA 92354-3833
Phone
(909) 796-0101
NPI assigned
May 13, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 9, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 34372 CA Primary

Addresses

Primary practice location

11346 Mountain View Ave Ste B
Loma Linda, CA 92354-3833

Mailing address

7711 Melrose Ave
Rosemead, CA 91770-3075
Phone (626) 696-6961

Other practice location 1

5901 E 7th St
Long Beach, CA 90822-5201
Phone (844) 808-2020

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200710002108 CA Practitioner - Optometry 3274956172 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
University of California - School of Optometry, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Annessa Du, O.D., a Professional CorporationGroup PAC ID 8729445010, 3 clinicians

Practice addresses (Care Compare)

11346 Mountain View Ave
Suite B
Loma Linda, CA 92354-3833
Phone (909) 796-0101

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Annessa Du, O.D., a Professional Corporation Optometrist CurrentSince Apr 19, 2023 Accepting new patients
Eyecon Optometry Partnership Optometrist CurrentSince Sep 15, 2024 Accepting new patients

Locations

11346 Mountain View Ave
Ste B
Loma Linda, CA 92354
Phone (909) 769-0101

7217 Reseda Blvd
Reseda, CA 91335
Phone (818) 345-2010

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1557705600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1673222400000",
    "number": "1366008633",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7711 MELROSE AVE",
            "city": "ROSEMEAD",
            "state": "CA",
            "postal_code": "917703075",
            "telephone_number": "626-696-6961"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11346 MOUNTAIN VIEW AVE STE B",
            "city": "LOMA LINDA",
            "state": "CA",
            "postal_code": "923543833",
            "telephone_number": "909-796-0101"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5901 E 7th St",
            "address_purpose": "LOCATION",
            "city": "Long Beach",
            "state": "CA",
            "postal_code": "908225201",
            "country_code": "US",
            "telephone_number": "844-808-2020",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DU",
        "first_name": "ANNESSA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-05-13",
        "last_updated": "2023-01-09",
        "certification_date": "2023-01-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "34372",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Loma Linda, CA

Sources for this page

Verify at the official NPI Registry.