Jacqueline M. Cullinane,O.D. a Professional Corporation

Primary specialty

OptometristTaxonomy code 152W00000X

License

10306TPG Issued in CA

Legal business name

JACQUELINE M. CULLINANE,O.D. A PROFESSIONAL CORPORATION

Practice address

22741 Lambert St Ste 1601
Lake Forest, CA 92630-1617

Phone

(949) 581-6880

Fax

(949) 581-1341

NPI assigned

Jul 24, 2018

Organization subpart

No

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

Authorized official

Name

Teresa Bieda

Title

Office Manager

Phone

(949) 581-6880

Specialties & licenses 1

Addresses

Other names 2

• Lake Forest Optometry Doing business as
• Jacqueline M. Cullinane Former legal business name

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Jacqueline Marie Cullinane, OD

  • Optometrist
  • Lake Forest, CA
  • NPI 1689645046
  Medicare reassignment NPD

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

{
    "created_epoch": "1532390400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1541462400000",
    "number": "1437636255",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22741 LAMBERT ST STE 1601",
            "city": "LAKE FOREST",
            "state": "CA",
            "postal_code": "926301617",
            "telephone_number": "949-581-6880",
            "fax_number": "949-581-1341"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22741 LAMBERT ST STE 1601",
            "city": "LAKE FOREST",
            "state": "CA",
            "postal_code": "926301617",
            "telephone_number": "949-581-6880",
            "fax_number": "949-581-1341"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACQUELINE M. CULLINANE,O.D. A PROFESSIONAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-07-24",
        "last_updated": "2018-11-06",
        "status": "A",
        "authorized_official_last_name": "BIEDA",
        "authorized_official_first_name": "TERESA",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "949-581-6880"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "CA",
            "license": "10306TPG",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lake Forest Optometry",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Jacqueline M. Cullinane",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "Jacqueline M. Cullinane",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Seyed Reza Izadi Dehkordi, DDS
• J Puangco M.D., Inc.
• J. W. Schlingman Chiropractic, Inc.
• Gabrielle Jackson
• James Alan Jacobs I
• Matthew Thomas Jacquot
• James a Jacobs
• James L. Kay, D.O., P.C.
• Olivia Jaques
• Guadalupe Jara

• Optometrist in Lake Forest, CA
• Providers in Lake Forest, CA by specialty
• Optometrist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 6, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.