Individual provider Active NPI

Joann Henwood, O.D.

  • Optometrist
  • San Dimas, CA
National Provider Identifier
1689024523
Registry record updated Sep 2, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
33399 Issued in CA
Practice address
120 W Bonita Ave
Suite a
San Dimas, CA 91773-3085
Phone
(909) 599-1100
NPI assigned
Jun 21, 2016
Last updated
Sep 2, 2016By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 2, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 33399 CA Primary

Addresses

Primary practice location

120 W Bonita Ave
Suite a
San Dimas, CA 91773-3085

Mailing address

120 W Bonita Ave
Ste a
San Dimas, CA 91773-5000
Phone (909) 599-1100

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
I20160921000425 CA Practitioner - Optometry 7719274638 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

12442 Limonite Ave
Unit 200
Eastvale, CA 91752-2467
Phone (951) 737-4000

Merit-based Incentive Payment System (MIPS)

Final score
80.15 of 100Reported as group
Quality
76.08
Promoting interoperability
72
Improvement activities
40
Cost
75.13

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Suzan Burmayan, O.D., a Professional Corporation Optometrist CurrentSince Jul 21, 2024 Accepting new patients
Pacific Eye Institute a Medical Group Inc CurrentSince Apr 15, 2019 Accepting new patients
Pacific Eye Institute, a Medical Group, Inc. CurrentSince Apr 15, 2019 Accepting new patients

Locations

12442 Limonite Ave
Unit 200
Eastvale, CA 91752
Phone (951) 737-4000

9834 Genesee Ave
Ste 200
La Jolla, CA 92037
Phone (858) 457-3050

8112 Milliken Ave
Ste 203
Rancho Cucamonga, CA 91730
Phone (909) 945-3563

3939 3rd Ave
San Diego, CA 92103
Phone (619) 296-8525

120 W Bonita Ave
Ste A
San Dimas, CA 91773
Phone (909) 599-1100

555 N 13th Ave
Upland, CA 91786
Phone (909) 982-8846

591 N 13th Ave
Upland, CA 91786
Phone (909) 946-5320

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Organizations & group practices 3

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": "1466467200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1472774400000",
    "number": "1689024523",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "120 W BONITA AVE",
            "address_2": "STE A",
            "city": "SAN DIMAS",
            "state": "CA",
            "postal_code": "917735000",
            "telephone_number": "909-599-1100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "120 W BONITA AVE",
            "address_2": "SUITE A",
            "city": "SAN DIMAS",
            "state": "CA",
            "postal_code": "917733085",
            "telephone_number": "909-599-1100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HENWOOD",
        "first_name": "JOANN",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-06-21",
        "last_updated": "2016-09-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "33399",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Dimas, CA

Sources for this page

Verify at the official NPI Registry.