John Ilsun Ryu, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

11209T Issued in CA

Practice address

690 E Los Angeles Ave
Suite a
Simi Valley, CA 93065-1857

Phone

(626) 376-3513

Fax

(905) 250-1001

NPI assigned

Nov 8, 2006

Last updated

Jul 15, 2024By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

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

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• Summit Optometric Eyecare

  • Optometrist
  • Simi Valley, CA
  • NPI 1053757039
  Medicare reassignment Authorized official
• Dr. J. Solomon Moore, OD & Associates, Inc.

  • Optometrist
  • Van Nuys, CA
  • NPI 1780721944
  NPD (past)

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

{
    "created_epoch": "1162944000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721001600000",
    "number": "1609946847",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1194 KNOTTINGHAM ST",
            "city": "SIMI VALLEY",
            "state": "CA",
            "postal_code": "930655167",
            "telephone_number": "626-376-3513",
            "fax_number": "805-250-1001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "690 E LOS ANGELES AVE",
            "address_2": "SUITE A",
            "city": "SIMI VALLEY",
            "state": "CA",
            "postal_code": "930651857",
            "telephone_number": "626-376-3513",
            "fax_number": "905-250-1001"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RYU",
        "first_name": "JOHN",
        "middle_name": "ILSUN",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-11-08",
        "last_updated": "2024-07-15",
        "certification_date": "2024-07-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "11209T",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Darren Russell
• Shelby Russell
• RX Point Pharmacy Inc
• Courtney Ryan
• Lyndsey Ryburn, MOT, OTR/L
• S Tenggren Dental Corp (Simi Hills Dental)
• Joseph Zeta Sabino
• Marcia E Sack, MSRD
• Sack's Medical Nutrition Therapy, Inc.
• Marjan Sadeghi

• Optometrist in Simi Valley, CA
• Providers in Simi Valley, CA by specialty
• Optometrist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 2024; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.