Lakeside Optometry, PC

Primary specialty

OptometristTaxonomy code 152W00000X

License

11714T Issued in CA

Legal business name

LAKESIDE OPTOMETRY, PC

Practice address

3461 Brookside Rd Ste a-1
Stockton, CA 95219-1741

Phone

(209) 451-4305

Fax

(209) 622-4283

NPI assigned

Oct 26, 2016

Organization subpart

No

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

Authorized official

Name

Chinh T. Nguyen, O.D.NPI 1306921986

Title

President

Phone

(209) 451-4305

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Chinh T Nguyen, O.D.

  • Optometrist
  • Stockton, CA
  • NPI 1306921986
  Medicare reassignment Care Compare group Authorized official
• Orathay Thongsamouth, O.D.

  • Optometrist
  • Stockton, CA
  • NPI 1639273071
  Medicare reassignment Care Compare group

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

{
    "created_epoch": "1477440000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1477440000000",
    "number": "1700338779",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3461 BROOKSIDE RD STE A-1",
            "city": "STOCKTON",
            "state": "CA",
            "postal_code": "952191741",
            "telephone_number": "209-451-4305",
            "fax_number": "209-622-4283"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3461 BROOKSIDE RD STE A-1",
            "city": "STOCKTON",
            "state": "CA",
            "postal_code": "952191741",
            "telephone_number": "209-451-4305",
            "fax_number": "209-622-4283"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKESIDE OPTOMETRY, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-10-26",
        "last_updated": "2016-10-26",
        "status": "A",
        "authorized_official_last_name": "NGUYEN",
        "authorized_official_first_name": "CHINH",
        "authorized_official_middle_name": "T.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "209-451-4305",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": "CA",
            "license": "11714T",
            "primary": true
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": "CA",
            "license": "OPT 12656 TPL",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ellaha Yasamin Lail
• Gloria Stephen Laizer
• Crystal Dionne Lake-Akinnuoye, FNP-C
• Abbey Lake, RD, CNSC
• Miriam Claire Lakes, NP
• Lakeview Dental Care Office of Louis M. Orimo, D.D.S., Inc.
• Peter Valdis Lakis, LMSW-CC
• Radhika Lal
• Chanton Lam-Copeland
• Christopher Lam

• Optometrist in Stockton, CA
• Providers in Stockton, CA by specialty
• Optometrist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 26, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.