Individual provider Active NPI

Jeannie Situ, OD

  • Optometrist
  • Victorville, CA
National Provider Identifier
1528558269
Registry record updated May 17, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
33921TLG Issued in CA
Practice address
12234 Palmdale Rd
Victorville, CA 92392-9418
Phone
(760) 843-9752
NPI assigned
May 17, 2018
Last updated
May 17, 2018By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 17, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 33921TLG CA Primary

Addresses

Primary practice location

12234 Palmdale Rd
Victorville, CA 92392-9418

Mailing address

12234 Palmdale Rd
Victorville, CA 92392-9418

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
I20190712001560 CA Practitioner - Optometry 7315272382 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Southern California College of Optometry, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

12234 Palmdale Rd
Victorville, CA 92392-9418
Phone (760) 843-9752

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
33921TLGCAMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Jeannie Situ, O.D., Inc. Optometrist CurrentSince May 6, 2019 Accepting new patients

Locations

12234 Palmdale Rd
Victorville, CA 92392
Phone (760) 493-3279

Organizations & group practices 1

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": "1526515200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1526515200000",
    "number": "1528558269",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12234 PALMDALE RD",
            "city": "VICTORVILLE",
            "state": "CA",
            "postal_code": "923929418"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12234 PALMDALE RD",
            "city": "VICTORVILLE",
            "state": "CA",
            "postal_code": "923929418",
            "telephone_number": "760-843-9752"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SITU",
        "first_name": "JEANNIE",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-05-17",
        "last_updated": "2018-05-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "33921TLG",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Victorville, CA

Sources for this page

Verify at the official NPI Registry.