Andy Keith Kongsakul, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

TUV007213-1 Issued in NY

Practice address

19636 Sherman Way
Reseda, CA 91335-3647

Phone

(818) 774-2020

Fax

(818) 774-2021

NPI assigned

Sep 4, 2007

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Dr. Andy Keith Kongsakul Professional name

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

Specialty

Optometry

Education

Other, 2007

Medicare assignment

May accept Medicare assignment

Group practices

Valley Optometry Eyecare Center, Inc.Group PAC ID 3173678588, 3 clinicians

El Portal Optometry IncGroup PAC ID 6305124223, 2 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• El Portal Optometry, Inc

  dba Valley Optometry Eyecare of North Hollywood

  • Optometrist
  • North Hollywood, CA
  • NPI 1215212626
  Medicare reassignment Care Compare group NPD Authorized official
• Valley Optometry Eyecare Center, Inc.

  dba Valley Optometry Eyecare

  • Optometrist
  • Reseda, CA
  • NPI 1649400920
  Medicare reassignment Care Compare group NPD Authorized official
• Hillside Optometry Inc

  dba Hillside Optometry

  • Optometrist
  • Granada Hills, CA
  • NPI 1457060857
  Medicare reassignment NPD Authorized official
• Clear Vision Optometry, Inc.

  • Optometrist
  • North Hollywood, CA
  • NPI 1669666723
  NPD (past)

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

{
    "created_epoch": "1188864000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1780963200000",
    "number": "1497949267",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19636 SHERMAN WAY",
            "city": "RESEDA",
            "state": "CA",
            "postal_code": "913353647",
            "telephone_number": "818-774-2020",
            "fax_number": "818-774-2021"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19636 SHERMAN WAY",
            "city": "RESEDA",
            "state": "CA",
            "postal_code": "913353647",
            "telephone_number": "818-774-2020",
            "fax_number": "818-774-2021"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "16907 San Fernando Mission Blvd",
            "address_purpose": "LOCATION",
            "city": "Granada Hills",
            "state": "CA",
            "postal_code": "913444250",
            "country_code": "US",
            "telephone_number": "818-474-2020",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "5269 Lankershim Blvd",
            "address_purpose": "LOCATION",
            "city": "North Hollywood",
            "state": "CA",
            "postal_code": "916013111",
            "country_code": "US",
            "telephone_number": "818-769-2020",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KONGSAKUL",
        "first_name": "ANDY",
        "middle_name": "KEITH",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-09-04",
        "last_updated": "2026-06-09",
        "certification_date": "2026-06-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "13639T",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NY",
            "license": "TUV007213-1",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1649400920",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ANDY",
            "last_name": "KONGSAKUL",
            "middle_name": "KEITH",
            "prefix": "DR.",
            "credential": "O.D.",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

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• Optometrist in Reseda, CA
• Providers in Reseda, CA by specialty
• Optometrist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 9, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.