Active NPI
Kyle Mingsang Lee, O.D.
- Optometrist
- Elk Grove, CA
National Provider Identifier
1386779585
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 11013T
- Practice address
- 9237 Laguna Lake Way
Elk Grove, CA 95758-4236 - Phone
- (415) 652-2139
- Fax
- (510) 889-1519
- NPI assigned
- Feb 21, 2007
- Sex
- Male
- Sole proprietor
- Yes
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 | 11013T | CA | Primary |
Addresses
Primary practice location
9237 Laguna Lake Way
Elk Grove, CA 95758-4236
Mailing address
9237 Laguna Lake Way
Elk Grove, CA 95758-4236
Phone (415) 652-2139
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 11013T | CA | MD | Optometrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Pearle Visioncare, Inc | Past | Accepting new patients | |
| Pearle Visioncare, Inc | Past | Accepting new patients |
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.
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- Eyewear Supplier
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- NPI 1508921594
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1172016000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1386779585",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9237 LAGUNA LAKE WAY",
"city": "ELK GROVE",
"state": "CA",
"postal_code": "957584236",
"telephone_number": "415-652-2139",
"fax_number": "510-889-1519"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9237 LAGUNA LAKE WAY",
"city": "ELK GROVE",
"state": "CA",
"postal_code": "957584236",
"telephone_number": "415-652-2139",
"fax_number": "510-889-1519"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LEE",
"first_name": "KYLE",
"middle_name": "MINGSANG",
"name_prefix": "Dr.",
"credential": "O.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-02-21",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "CA",
"license": "11013T",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Elk Grove, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.