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
- Last updated
- Jul 8, 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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
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.