Active NPI
Stacey Ann De Yong, O.D.
- Optometrist
- Irvine, CA
National Provider Identifier
1538224472
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 12778
- Practice address
- 13662A Jamboree Rd
The Market Place II
Irvine, CA 92602-1201 - Phone
- (714) 508-4970
- Fax
- (714) 508-4971
- NPI assigned
- Dec 22, 2006
- Last updated
- Jul 8, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 12778 | CA | Primary |
Addresses
Primary practice location
13662A Jamboree Rd
The Market Place II
Irvine, CA 92602-1201
Mailing address
28841 Glen RDG
Mission Viejo, CA 92692-4301
Phone (949) 680-5420
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 12778 | CA | MD | Optometrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Luxottica of America Inc. | Past | Accepting new patients | |
| Luxottica of America Inc | Past | Accepting new patients |
Organizations & group practices 2
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": "1166745600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1538224472",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "28841 GLEN RDG",
"city": "MISSION VIEJO",
"state": "CA",
"postal_code": "926924301",
"telephone_number": "949-680-5420"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "13662A JAMBOREE RD",
"address_2": "THE MARKET PLACE II",
"city": "IRVINE",
"state": "CA",
"postal_code": "926021201",
"telephone_number": "714-508-4970",
"fax_number": "714-508-4971"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DE YONG",
"first_name": "STACEY",
"middle_name": "ANN",
"credential": "O.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-12-22",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "CA",
"license": "12778",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Irvine, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.