Active NPI
Janice Kassawat, O.D.
- Optometrist
- Fountain Valley, CA
National Provider Identifier
1770909657
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 9721 TG
- Practice address
- 17900 Newhope St
Fountain Valley, CA 92708-5422 - Phone
- (714) 444-4225
- Fax
- (714) 444-4225
- NPI assigned
- Mar 14, 2014
- Sex
- Female
- Sole proprietor
- No
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 | 9721 TG | CA | Primary |
Addresses
Primary practice location
17900 Newhope St
Fountain Valley, CA 92708-5422
Mailing address
17900 Newhope St
Fountain Valley, CA 92708-5422
Phone (714) 444-4225
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
- Opted out of Medicare
- Yes, effective May 27, 2016 through May 27, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 9721 TG | CA | MD | Optometrist |
| 9721 | CA | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1394755200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1394755200000",
"number": "1770909657",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "17900 NEWHOPE ST",
"city": "FOUNTAIN VALLEY",
"state": "CA",
"postal_code": "927085422",
"telephone_number": "714-444-4225",
"fax_number": "714-444-4225"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "17900 NEWHOPE ST",
"city": "FOUNTAIN VALLEY",
"state": "CA",
"postal_code": "927085422",
"telephone_number": "714-444-4225",
"fax_number": "714-444-4225"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KASSAWAT",
"first_name": "JANICE",
"credential": "O.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2014-03-14",
"last_updated": "2014-03-14",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "CA",
"license": "9721 TG",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fountain Valley, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 14, 2014; 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; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.