Wan and Mashouf Optometric Corp PC

Primary specialty

OptometristTaxonomy code 152W00000X

License

10924T Issued in CA

Legal business name

WAN AND MASHOUF OPTOMETRIC CORP PC

Practice address

10549 Scripps Poway Pkwy
Ste G
San Diego, CA 92131-3963

Phone

(858) 530-2800

Fax

(858) 530-2889

NPI assigned

May 27, 2006

Organization subpart

No

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

Authorized official

Name

Keith Michael Wan, ODNPI 1235181165

Title

OD/Owner

Phone

(858) 530-2800

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Locations

Practitioners 4

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

• Keith Michael Wan, O.D.

  • Optometrist
  • San Diego, CA
  • NPI 1235181165
  Medicare reassignment Care Compare group Authorized official
• Danielle Mantione, O.D.

  • Optometrist
  • Temecula, CA
  • NPI 1124470042
  Medicare reassignment Care Compare group NPD
• Eng Ann Sung, OD

  • Optometrist
  • San Diego, CA
  • NPI 1912533134
  Medicare reassignment Care Compare group NPD
• Jay Michael Mashouf, O.D.

  • Corneal and Contact Management Optometrist
  • San Diego, CA
  • NPI 1346294584
  Medicare reassignment Care Compare group

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

{
    "created_epoch": "1148688000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1612396800000",
    "number": "1760439848",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10549 SCRIPPS POWAY PKWY",
            "address_2": "STE G",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921313963",
            "telephone_number": "858-530-2800",
            "fax_number": "858-530-2889"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10549 SCRIPPS POWAY PKWY",
            "address_2": "STE G",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921313963",
            "telephone_number": "858-530-2800",
            "fax_number": "858-530-2889"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WAN AND MASHOUF OPTOMETRIC CORP PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-27",
        "last_updated": "2021-02-04",
        "certification_date": "2021-02-04",
        "status": "A",
        "authorized_official_last_name": "WAN",
        "authorized_official_first_name": "KEITH",
        "authorized_official_middle_name": "MICHAEL",
        "authorized_official_title_or_position": "OD/OWNER",
        "authorized_official_telephone_number": "858-530-2800",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "CA",
            "license": "10924T",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Zachary Doyle Walton, M.D., PH.D.
• Aleandro Waltower
• Michael Joseph Waltz
• Andrew Wampach
• Brian W. Wamsley, MD
• Devon Lia-Soan Wan, DMD
• Keith Michael Wan, O.D.
• Lori Wan, MD
• Taylor Harrison Wand, MD
• Joseph Daniel Wandzilak, RN

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 4, 2021; 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.