Individual provider Active NPI

Jon H Yamane, OD

  • Optometrist
  • Huntington Beach, CA
National Provider Identifier
1417927047
Registry record updated Apr 25, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
12380TPL Issued in CA
Practice address
18685 Main St
Ste E
Huntington Beach, CA 92648
Phone
(714) 847-1271
Fax
(714) 362-9533
NPI assigned
Jan 25, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 25, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 12380TPL CA Primary

Addresses

Primary practice location

18685 Main St
Ste E
Huntington Beach, CA 92648

Mailing address

1545 Nutmeg PL
Costa Mesa, CA 92626-2560
Phone (714) 847-1271

Other identifiers 1

IdentifierTypeStateIssuer
5582835MedicaidCA

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
I20031226000265 CA Practitioner - Optometry 8022916154 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Illinois College of Optometry at Chicago, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

1545 Nutmeg PL
Costa Mesa, CA 92626-2503
Phone (714) 847-1271

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
12380TPLCAMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Jon H. Yamane, O.D., Inc. Optometrist CurrentSince Aug 16, 2012 Accepting new patients
Richard J. Miyamoto, O.D Optometrist Past Accepting new patients

Locations

1545 Nutmeg Pl
Costa Mesa, CA 92626
Phone (714) 435-1150

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": "1138147200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1524614400000",
    "number": "1417927047",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1545 NUTMEG PL",
            "city": "COSTA MESA",
            "state": "CA",
            "postal_code": "926262560",
            "telephone_number": "714-847-1271",
            "fax_number": "714-362-9533"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18685 MAIN ST",
            "address_2": "STE E",
            "city": "HUNTINGTON BEACH",
            "state": "CA",
            "postal_code": "92648",
            "telephone_number": "714-847-1271",
            "fax_number": "714-362-9533"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "YAMANE",
        "first_name": "JON",
        "middle_name": "H",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-01-25",
        "last_updated": "2018-04-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "12380TPL",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5582835",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Huntington Beach, CA

Sources for this page

Verify at the official NPI Registry.