NPIMap

Organization Active NPI

Spectrum Eye Physicians, a Medical Corporation

  • Ophthalmology Physician
  • Cupertino, CA
National Provider Identifier
1487601522
Registry record updated Feb 2, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
Legal business name
SPECTRUM EYE PHYSICIANS, A MEDICAL CORPORATION
Practice address
10300 S de Anza Blvd
Suite a
Cupertino, CA 95014-3030
Phone
(408) 253-3083
Fax
(408) 253-2965
NPI assigned
May 27, 2006
Last updated
Feb 2, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 2, 2016

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

Authorized official

Name
Mr. Joel Wilhelm, COE
Title
Administrator/Controller
Phone
(408) 252-7310

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 152W00000X OPT 13831 TLG CA
Ophthalmology PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207W00000X CA Primary
Eyewear Supplier 332H00000X SRYGH 97-67584700006 CA

Addresses

Primary practice location

10300 S de Anza Blvd
Suite a
Cupertino, CA 95014-3030

Mailing address

10300 S de Anza Blvd
Suite a
Cupertino, CA 95014-3030
Phone (408) 253-3083

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050331001165 CA Part B Supplier - Clinic/Group Practice 2961459094 Receives reassigned benefits from 22 practitioners
Practice locations: Freedom, CA; Cupertino, CA; Santa Cruz, CA; San Jose, CA; Los Gatos, CA; Hollister, CA

National Provider Directory

National Provider Directory

Locations

10311 S De Anza Blvd
Cupertino, CA 95014
Phone (408) 609-6540

930 Sunnyslope Rd
Ste E
Hollister, CA 95023
Phone (831) 637-0705

2110 Forest Ave
Ste B
San Jose, CA 95128
Phone (408) 295-3433

1595 Soquel Dr
Ste 230
Santa Cruz, CA 95065
Phone (831) 226-3225

1665 Dominican Way
Ste 212
Santa Cruz, CA 95065

1665 Dominican Way
Ste 223
Santa Cruz, CA 95065

1665 Dominican Way
Ste 224
Santa Cruz, CA 95065
Phone (831) 246-8772

Networks

  • BSC 65 PLUS INDIVIDUAL MAPDPlans: Blue Shield 65 Plus (HMO) (H0504-015-000, H0504); Blue Shield 65 Plus (HMO) (H0504-039-000, H0504); Blue Shield 65 Plus Plan 2 (HMO) (H0504-021-000, H0504); Blue Shield Inspire (HMO) (H0504-041-000, H0504); Blue Shield 65 Plus (HMO) (H0504-038-000, H0504); Blue Shield Inspire (HMO) (H0504-047-000, H0504); Blue Shield 65 Plus (HMO) (H0504-026-000, H0504); Blue Shield Advantage (HMO) (H0504-050-000, H0504); Blue Shield AdvantageOptimum Plan (HMO) (H5928-004-000, H5928); Blue Shield Inspire (HMO) (H0504-043-000, H0504)…

Interoperability endpoints

  • Direct secure messaging: achang@sep.intellechartdirect.net
  • Direct secure messaging: awinn@sep.intellechartdirect.net
  • Direct secure messaging: bcarey@sep.intellechartdirect.net
  • Direct secure messaging: htruong@sep.intellechartdirect.net
  • Direct secure messaging: jpaik@sep.intellechartdirect.net
  • Direct secure messaging: ktran@sep.intellechartdirect.net
  • Direct secure messaging: schan@sep.intellechartdirect.net

Practitioners & affiliated clinicians

Practitioners 24

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 24

NPI Registry JSON

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

{
    "created_epoch": "1148688000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1454371200000",
    "number": "1487601522",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10300 S DE ANZA BLVD",
            "address_2": "SUITE A",
            "city": "CUPERTINO",
            "state": "CA",
            "postal_code": "950143030",
            "telephone_number": "408-253-3083",
            "fax_number": "408-253-2965"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10300 S DE ANZA BLVD",
            "address_2": "SUITE A",
            "city": "CUPERTINO",
            "state": "CA",
            "postal_code": "950143030",
            "telephone_number": "408-253-3083",
            "fax_number": "408-253-2965"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPECTRUM EYE PHYSICIANS, A MEDICAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-27",
        "last_updated": "2016-02-02",
        "status": "A",
        "authorized_official_last_name": "WILHELM",
        "authorized_official_first_name": "JOEL",
        "authorized_official_title_or_position": "ADMINISTRATOR/CONTROLLER",
        "authorized_official_telephone_number": "408-252-7310",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "COE"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": "CA",
            "license": "OPT 13831 TLG",
            "primary": false
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Ophthalmology",
            "state": "CA",
            "license": null,
            "primary": true
        },
        {
            "code": "332H00000X",
            "taxonomy_group": "",
            "desc": "Eyewear Supplier",
            "state": "CA",
            "license": "SRYGH 97-67584700006",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Cupertino, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 2, 2016; 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.