Individual provider Active NPI

Robert Ken Lee, O.D.

  • Optometrist
  • Brea, CA
National Provider Identifier
1528291267
Registry record updated Jan 25, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
13811 Issued in CA
Practice address
1040B East Imperial Highway
Brea, CA 92821
Phone
(714) 990-3881
NPI assigned
Aug 28, 2009
Last updated
Jan 25, 2016By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 25, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 13811 CA Primary

Addresses

Primary practice location

1040B East Imperial Highway
Brea, CA 92821

Mailing address

765 San Antonio Rd
Apt 56
Palo Alto, CA 94303-4816
Phone (650) 814-2278

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20161202001335 CA Practitioner - Optometry 1850695305 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
State University of New York - State College Optometry, 2009
Medicare assignment
May accept Medicare assignment
Group practices
Spectrum Eye Physicians a Medical CorporationGroup PAC ID 2961459094, 15 clinicians
Advance Vision Center of Optometry P CGroup PAC ID 6507801818, 4 clinicians

Practice addresses (Care Compare)

212 Oak Meadow Dr
Los Gatos, CA 95032-4407
Phone (408) 354-4740

545 Meridian Ave
Suite G
San Jose, CA 95126-3451
Phone (408) 947-2020

Merit-based Incentive Payment System (MIPS)

Final score
87.11 of 100Reported as group
Quality
88.99
Improvement activities
40
Cost
71.73

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Advance Vision Center of Optometry, P C CurrentSince Nov 17, 2016 Accepting new patients
Spectrum Eye Physicians, a Medical Corporation Optometrist CurrentSince Jan 1, 2022 Accepting new patients
Spectrum Eye Physicians, a Medical Corporation Optometrist CurrentSince Jan 1, 2022 Accepting new patients

Locations

10300 S De Anza Blvd
Cupertino, CA 95014
Phone (408) 252-7310

10300 S De Anza Blvd
Ste A
Cupertino, CA 95014
Phone (408) 253-3083

212 Oak Meadow Dr
Los Gatos, CA 95032
Phone (408) 354-4740

393 Blossom Hill Rd
Ste 265
San Jose, CA 95123
Phone (408) 227-7122

545 Meridian Ave
Ste G
San Jose, CA 95126
Phone (408) 947-2020

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1251417600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1453680000000",
    "number": "1528291267",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "765 SAN ANTONIO RD",
            "address_2": "APT 56",
            "city": "PALO ALTO",
            "state": "CA",
            "postal_code": "943034816",
            "telephone_number": "650-814-2278"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1040B EAST IMPERIAL HIGHWAY",
            "city": "BREA",
            "state": "CA",
            "postal_code": "92821",
            "telephone_number": "714-990-3881"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LEE",
        "first_name": "ROBERT",
        "middle_name": "KEN",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-08-28",
        "last_updated": "2016-01-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "13811",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brea, CA

Sources for this page

Verify at the official NPI Registry.