Spectrum Eye Physicians, a Medical Corporation
Organization Active NPI Ophthalmology Physician · Cupertino, CA
NPI 1487601522 · NPPES record last updated Feb 2, 2016
Key facts
- NPI
- 1487601522
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Ophthalmology Physician 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
- Organization subpart
- No
Authorized official
- Name
- Mr. Joel Wilhelm, COE
- Title
- Administrator/Controller
- Phone
- (408) 252-7310
Practitioners 24
-
Ryan Basham, MD
-
Stephanie Sara Chan, O.D.
-
Aimee C. Chang, MD
-
Tarek El-Sawy, M.D.
-
Martin L Fishman, M.D.
-
Robert Ken Lee, O.D.
-
James C Liu, M.D.
-
Robert S Mastman, M.D.
-
Yohko Murakami, M.D.
-
Jeanie Paik, M.D.
-
Sonya Minha Park, M.D.
-
Shelsea Rachelle Winkler, O.D.
-
Peishan Wu, OD
-
Joanne D Du, OD
-
Bart Alan Carey, MD
-
Conrad Hamako, MD
-
William Andrew Maxwell, M.D.
-
Helen H Truong, OD
-
Jeffrey Zhou Tsao, M.D.
-
Alexis Winn, O.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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
Locations
10311 S De Anza Blvd
Cupertino, CA 95014
Phone (408) 609-6540
431 Monterey Ave
Ste 3
Los Gatos, CA 95030
Phone (408) 354-9510
212 Oak Meadow Dr
Los Gatos, CA 95032
Phone (408) 354-4740
2577 Samaritan Dr
Ste 740
San Jose, CA 95124
Phone (408) 252-7310
2110 Forest Ave
Ste B
San Jose, CA 95128
Phone (408) 295-3433
1665 Dominican Way
Ste 223
Santa Cruz, CA 95065
1663 Dominican Way
Ste 212
Santa Cruz, CA 95065
Phone (831) 226-2636
1665 Dominican Way
Ste 212
Santa Cruz, CA 95065
Networks
- BSC 65 PLUS INDIVIDUAL MAPD
Interoperability endpoints
- jpaik@sep.intellechartdirect.net
- awinn@sep.intellechartdirect.net
- achang@sep.intellechartdirect.net
- schan@sep.intellechartdirect.net
- bcarey@sep.intellechartdirect.net
- htruong@sep.intellechartdirect.net
- ktran@sep.intellechartdirect.net
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist |
152W00000X | OPT 13831 TLG | CA | |
| Ophthalmology Physician |
207W00000X | CA | Yes | |
| 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
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| GR0103602 | Medicaid | CA | |
| GR0103600 | Medicaid | CA | |
| GR0103601 | Medicaid | CA | |
| GR0103603 | Medicaid | CA |
Other providers in Cupertino, CA
- Joshua Bryon Soriano
- Mojdeh Sorooshian
- Donna Sparagna
- Barbara Lynn Spark
- Jessica Sparks
- Spencer Hau Chiropractic Corp
- Matthew G Spero
- Ivria Spieler
- Neela Srinivas
- St. Jude Radiology Medical Group, Inc
All providers in Cupertino, CA · Ophthalmology Physician in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 2, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.