Individual provider Active NPI

Susan Hyun Joo Kim-Laubach, OD

  • Optometrist
  • Pleasanton, CA
National Provider Identifier
1619003910
Registry record updated Aug 25, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
9880T Issued in CA
Practice address
5980 Stoneridge Dr
Ste 110
Pleasanton, CA 94588-2723
Phone
(925) 463-7330
NPI assigned
Feb 23, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 25, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 9880T CA Primary

Addresses

Primary practice location

5980 Stoneridge Dr
Ste 110
Pleasanton, CA 94588-2723

Mailing address

5980 Stoneridge Dr
Ste 110
Pleasanton, CA 94588-2723
Phone (925) 463-7330

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
I20050721000499 CA Practitioner - Optometry 4688601610

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
9880TCAMDOptometrist
9880CAMDHome Health Aide

Practice roles

OrganizationSpecialtyStatusNew patients
Advanced Eyecare Professional Optometric Group Optometrist PastSince May 28, 2011 Accepting new patients

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1172188800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1756080000000",
    "number": "1619003910",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5980 STONERIDGE DR",
            "address_2": "STE 110",
            "city": "PLEASANTON",
            "state": "CA",
            "postal_code": "945882723",
            "telephone_number": "925-463-7330",
            "fax_number": "925-463-7337"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5980 STONERIDGE DR",
            "address_2": "STE 110",
            "city": "PLEASANTON",
            "state": "CA",
            "postal_code": "945882723",
            "telephone_number": "925-463-7330"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIM-LAUBACH",
        "first_name": "SUSAN",
        "middle_name": "HYUN JOO",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-02-23",
        "last_updated": "2025-08-25",
        "certification_date": "2025-08-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "9880T",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pleasanton, CA

Sources for this page

Verify at the official NPI Registry.