Individual provider Active NPI

Andrea Wai Yan Wong, O.D.

  • Optometrist
  • San Jose, CA
National Provider Identifier
1720387715
Registry record updated Sep 14, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
14015 TLG Issued in CA
Practice address
1066 S White Rd Ste 170
San Jose, CA 95127-3812
Phone
(408) 729-9700
NPI assigned
Mar 16, 2011
Last updated
Sep 14, 2026By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 14, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 14015 TLG CA Primary

Addresses

Primary practice location

1066 S White Rd Ste 170
San Jose, CA 95127-3812

Mailing address

40910 Fremont Blvd
Fremont, CA 94538-4375
Phone (408) 729-9700

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
I20151012002217 CA Practitioner - Optometry 1153630298 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Southern California College of Optometry, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Bay Area Community HealthGroup PAC ID 1658349824, 106 clinicians

Practice addresses (Care Compare)

5504 Monterey Hwy
San Jose, CA 95138-1529
Phone (408) 729-9700

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
14015 TLGCAMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Bay Area Community Health CurrentSince Oct 29, 2022 Accepting new patients
Bay Area Community Health CurrentSince Oct 29, 2022 Accepting new patients
Bay Area Community Health Past Accepting new patients

Locations

40910 Fremont Blvd
Fremont, CA 94538
Phone (510) 770-8133

1066 S White Rd
Ste 170
San Jose, CA 95127

1650 S White Rd
San Jose, CA 95127
Phone (408) 928-5250

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

  • Direct secure messaging: awong330554@direct.ochin.org

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": "1300233600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1789344000000",
    "number": "1720387715",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "40910 FREMONT BLVD",
            "city": "FREMONT",
            "state": "CA",
            "postal_code": "945384375",
            "telephone_number": "408-729-9700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1066 S WHITE RD STE 170",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951273812",
            "telephone_number": "408-729-9700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WONG",
        "first_name": "ANDREA",
        "middle_name": "WAI YAN",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-03-16",
        "last_updated": "2026-09-14",
        "certification_date": "2026-09-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "14015 TLG",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Jose, CA

Sources for this page

Verify at the official NPI Registry.