Active NPI
Mark S Douangchak, O.D.
- Optometrist
- Santa Ana, CA
National Provider Identifier
1760762058
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 14138
- Practice address
- 2800 N Main St
Suite 104
Santa Ana, CA 92705-6607 - Phone
- (714) 547-8194
- Fax
- (714) 547-5626
- NPI assigned
- Aug 18, 2011
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 14138 | CA | Primary |
Addresses
Primary practice location
2800 N Main St
Suite 104
Santa Ana, CA 92705-6607
Mailing address
5874 Apia Dr
Cypress, CA 90630-5505
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1313625600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1313625600000",
"number": "1760762058",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5874 APIA DR",
"city": "CYPRESS",
"state": "CA",
"postal_code": "906305505"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2800 N MAIN ST",
"address_2": "SUITE 104",
"city": "SANTA ANA",
"state": "CA",
"postal_code": "927056607",
"telephone_number": "714-547-8194",
"fax_number": "714-547-5626"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DOUANGCHAK",
"first_name": "MARK",
"middle_name": "S",
"name_prefix": "Dr.",
"credential": "O.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2011-08-18",
"last_updated": "2011-08-18",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "CA",
"license": "14138",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Santa Ana, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 18, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.