Dianne Lee Wong, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

11780 Issued in CA

Practice address

901 E St
Ste 285
San Rafael, CA 94901-2850

Phone

(415) 454-5565

Fax

(415) 454-2957

NPI assigned

May 31, 2005

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

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

Specialty

Optometry

Education

University of California - School of Optometry, 2001

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Permanente Medical Group IncGroup PAC ID 8921910225, 10,928 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: dianne.wong.p1@direct.marineyes.nextgenshare.com

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.

• Permanente Medical Group Inc

  • Internal Medicine Physician
  • Santa Clara, CA
  • NPI 1073606299
  Medicare reassignment Care Compare group NPD
• Bach-Kim Nguyen, O.D.

  • Optometrist
  • Walnut Creek, CA
  • NPI 1942235734
  Medicare reassignment
• Permanente Medical Group Inc

  • Internal Medicine Physician
  • Vallejo, CA
  • NPI 1336222397
  NPD
• Permanente Medical Group, Inc

  • Clinical Medical Laboratory
  • San Jose, CA
  • NPI 1497971584
  NPD
• Vallejo Optometry Group

  • Optometrist
  • Vallejo, CA
  • NPI 1285771592
  NPD (past)
• Walnut Creek Optometry Group

  • Optometrist
  • Walnut Creek, CA
  • NPI 1528147048
  NPD (past)

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

{
    "created_epoch": "1117497600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1641168000000",
    "number": "1750384061",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "901 E ST",
            "address_2": "STE 285",
            "city": "SAN RAFAEL",
            "state": "CA",
            "postal_code": "949012850",
            "telephone_number": "415-454-5565",
            "fax_number": "415-454-2957"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "901 E ST",
            "address_2": "STE 285",
            "city": "SAN RAFAEL",
            "state": "CA",
            "postal_code": "949012850",
            "telephone_number": "415-454-5565",
            "fax_number": "415-454-2957"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WONG",
        "first_name": "DIANNE",
        "middle_name": "LEE",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-05-31",
        "last_updated": "2022-01-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "11780",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0015750",
            "state": "CA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ncalceq",
            "affiliation": "Y",
            "endpointDescription": "Carequality",
            "affiliationName": "The Permanente Medical Group",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "1033 3rd St",
            "city": "San Rafael",
            "state": "CA",
            "country_code": "US",
            "postal_code": "949013107",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Johanna Wolfson, PH.D.
• Women'S and Children'S Health Ca, P.C.
• Phyllis Won, PA-C
• Albert Wong, PHD
• Caitlin Wong
• Eric Bao- Toan Wong, D.D.S.
• Haymond Wong, PHARM.D
• Joyce Enriquez Wong, PHARMD
• Kenneth Wong, PHARMD
• Nora Louie Wong, PHARM D

• Optometrist in San Rafael, CA
• Providers in San Rafael, CA by specialty
• Optometrist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 3, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.