Individual provider Active NPI

Charlene Anne Trinidad, O.D.

  • Optometrist
  • Brea, CA
National Provider Identifier
1710393228
Registry record updated Feb 26, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
34507 Issued in CA
Practice address
1065 Brea Mall Ste 1012
Brea, CA 92821-5718
Phone
(562) 631-0830
NPI assigned
Jul 3, 2014
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 26, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 34507 CA Primary

Addresses

Primary practice location

1065 Brea Mall Ste 1012
Brea, CA 92821-5718

Mailing address

1065 Brea Mall Ste 1012
Brea, CA 92821-5718

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NV, CA2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20141009000270 NV Practitioner - Optometry 3476773763 Reassigns benefits to 2 organizations
I20220113002167 CA Practitioner - Optometry 3476773763 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
34507CAMDClinical Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Kopolow & Girisgen Professional Corporation Optometrist CurrentSince Aug 9, 2014 Accepting new patients
Girisgen & Kopolow OD, PC Optometrist CurrentSince Aug 9, 2014 Accepting new patients
Girisgen & Kopolow OD, PC Optometrist CurrentSince Aug 9, 2014 Accepting new patients
Girisgen & Kopolow OD, PC Optometrist Current Accepting new patients
Eye Care West Optometry Oc Optometrist CurrentSince Dec 3, 2021 Accepting new patients

Locations

26750 Towne Centre Dr
Ste E
Foothill Rnch, CA 92610
Phone (949) 215-0505

75 S Valle Verde Dr
Ste 120
Henderson, NV 89012

4045 Spencer St
Ste A59
Las Vegas, NV 89119
Phone (702) 437-5521

7361 W Lake Mead Blvd
Ste 104
Las Vegas, NV 89128
Phone (702) 341-7254

Interoperability endpoints

  • Direct secure messaging: charlene.trinidad@uprisedirect.com

Organizations & group practices 5

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": "1404345600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1645833600000",
    "number": "1710393228",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1065 BREA MALL STE 1012",
            "city": "BREA",
            "state": "CA",
            "postal_code": "928215718"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1065 BREA MALL STE 1012",
            "city": "BREA",
            "state": "CA",
            "postal_code": "928215718",
            "telephone_number": "562-631-0830"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TRINIDAD",
        "first_name": "CHARLENE",
        "middle_name": "ANNE",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-07-03",
        "last_updated": "2022-02-26",
        "certification_date": "2022-02-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "34507",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brea, CA

Sources for this page

Verify at the official NPI Registry.