Kristina Dea, OD
Individual provider Active NPI Optometrist · Moorpark, CA
NPI 1669158606 · NPPES record last updated Jun 26, 2023
Key facts
- NPI
- 1669158606
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Optometrist 152W00000X
- License
- OPT35495-TLG (CA)
- Practice address
- 766 New Los Angeles Ave Ste D-3
Moorpark, CA 93021-3600 - Phone
- (805) 523-3440
- NPI assigned
- Jun 26, 2023
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Medicare Care Compare profile
- Specialty
- Optometry
- Education
- Southern California College of Optometry, 2023
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Advanced Family Vision Center Inc
Practice addresses (Care Compare)
766 W Los Angeles Ave
Suite D3
Moorpark, CA 93021-1756
Phone (805) 523-3440
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20230713001737 | CA | Practitioner - Optometry | 0840650594 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| OPT35495-TLG | CA | MD | Optometrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Advanced Family Vision Center Inc | Optometrist | Current |
Accepting new patients |
| Advanced Family Vision Center Optometry | Optometrist | Past |
Accepting new patients |
Locations
766 New Los Angeles Ave
Ste D3
Moorpark, CA 93021
Phone (805) 523-3440
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | OPT35495-TLG | CA | Yes |
Addresses
Primary practice location
766 New Los Angeles Ave Ste D-3
Moorpark, CA 93021-3600
Mailing address
489 Arbor St
Camarillo, CA 93012-7842
Other providers in Moorpark, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 26, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.