NPIMap

Organization Active NPI

Mi Mi Optometric Center Inc

  • Optometrist
  • Garden Grove, CA
National Provider Identifier
1518290303
Registry record updated Jun 25, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
12426T Issued in CA
Legal business name
MI MI OPTOMETRIC CENTER INC
Practice address
9636 Garden Grove Blvd Ste 5
Garden Grove, CA 92844
Phone
(714) 537-1313
Fax
(714) 537-9180
NPI assigned
Sep 10, 2009
Last updated
Jun 25, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 25, 2018

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

Authorized official

Name
Dr. Sheryn S Lee, ODNPI 1457442410
Title
OD
Phone
(714) 537-1313

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 12426T CA Primary

Addresses

Primary practice location

9636 Garden Grove Blvd Ste 5
Garden Grove, CA 92844

Mailing address

9636 Garden Grove Blvd Ste 5
Garden Grove, CA 92844-1590
Phone (714) 537-1313

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20091002000631 CA Part B Supplier - Clinic/Group Practice 3375689490 Receives reassigned benefits from 2 practitioners
Practice locations: Garden Grove, CA

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Mi Mi Optometric Centerinc2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

9636 Garden Grove Blvd
Ste 5
Garden Grove, CA 92844
Phone (714) 537-1313

Practitioners & affiliated clinicians

Practitioners 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1252540800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1529884800000",
    "number": "1518290303",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9636 GARDEN GROVE BLVD STE 5",
            "city": "GARDEN GROVE",
            "state": "CA",
            "postal_code": "928441590",
            "telephone_number": "714-537-1313",
            "fax_number": "714-537-9180"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9636 GARDEN GROVE BLVD STE 5",
            "city": "GARDEN GROVE",
            "state": "CA",
            "postal_code": "92844",
            "telephone_number": "714-537-1313",
            "fax_number": "714-537-9180"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MI MI OPTOMETRIC CENTER INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-09-10",
        "last_updated": "2018-06-25",
        "status": "A",
        "authorized_official_last_name": "LEE",
        "authorized_official_first_name": "SHERYN",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "OD",
        "authorized_official_telephone_number": "714-537-1313",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "12426T",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Garden Grove, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 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.