Individual provider Active NPI

Michelle Min-Gee Wong, O.D.

  • Optometrist
  • San Leandro, CA
National Provider Identifier
1790124162
Registry record updated Aug 10, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
OPT 15300 TLG Issued in CA
Practice address
1598 Washington Ave
San Leandro, CA 94577-4465
Phone
(510) 895-2116
Fax
(510) 895-2316
NPI assigned
Jun 19, 2013
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 10, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X OPT 15300 TLG CA Primary

Addresses

Primary practice location

1598 Washington Ave
San Leandro, CA 94577-4465

Mailing address

1598 Washington Ave
San Leandro, CA 94577-4465
Phone (510) 895-2116

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
I20161005002279 CA Practitioner - Optometry 7012225600 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Shelly Y Sheppard OD IncGroup PAC ID 3870913312, 2 clinicians

Practice addresses (Care Compare)

1801 Santa Clara Ave
Alameda, CA 94501-2631
Phone (510) 521-2015

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
OPT 15300 TLGCAMDOptometrist
15300CAMDOccupational Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Shelly Y. Sheppard OD Inc. Optometrist CurrentSince Jun 1, 2021 Accepting new patients

Locations

1801 Santa Clara Ave
Alameda, CA 94501
Phone (510) 521-2015

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1371600000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1470787200000",
    "number": "1790124162",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1598 WASHINGTON AVE",
            "city": "SAN LEANDRO",
            "state": "CA",
            "postal_code": "945774465",
            "telephone_number": "510-895-2116",
            "fax_number": "510-895-2316"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1598 WASHINGTON AVE",
            "city": "SAN LEANDRO",
            "state": "CA",
            "postal_code": "945774465",
            "telephone_number": "510-895-2116",
            "fax_number": "510-895-2316"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WONG",
        "first_name": "MICHELLE",
        "middle_name": "MIN-GEE",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2013-06-19",
        "last_updated": "2016-08-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "OPT 15300 TLG",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Leandro, CA

Sources for this page

Verify at the official NPI Registry.