NPIMap

Organization Active NPI

Imperial Beach Optometric Corporation

Doing business as Optom-Eyes Vision Care

  • Optometrist
  • San Diego, CA
National Provider Identifier
1790249563
Registry record updated Jul 3, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
Legal business name
IMPERIAL BEACH OPTOMETRIC CORPORATION
Doing business as
Optom-Eyes Vision Care
Practice address
1555 Palm Ave Ste A2
San Diego, CA 92154-1012
Phone
(619) 297-2020
Fax
(888) 210-5799
NPI assigned
Jan 25, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 3, 2025

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

Authorized official

Name
May Tam, ODNPI 1548255896
Title
Iboc Vice President
Phone
(619) 297-2020

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X Primary

Addresses

Primary practice location

1555 Palm Ave Ste A2
San Diego, CA 92154-1012

Mailing address

1555 Palm Ave Ste A2
San Diego, CA 92154-1012
Phone (619) 297-2020

Other practice location 1

812 N Imperial Ave
El Centro, CA 92243-1916
Phone (760) 352-7460

Other names 1

  • Optom-Eyes Vision Care Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20250813002039 CA Part B Supplier - Clinic/Group Practice 6901226497 Receives reassigned benefits from 9 practitioners
Practice locations: El Centro, CA; San Diego, CA

National Provider Directory

National Provider Directory

Locations

1555 Palm Ave
San Diego, CA 92154

Practitioners & affiliated clinicians

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1548374400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1751500800000",
    "number": "1790249563",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1555 PALM AVE STE A2",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921541012",
            "telephone_number": "619-297-2020",
            "fax_number": "888-210-5799"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1555 PALM AVE STE A2",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921541012",
            "telephone_number": "619-297-2020",
            "fax_number": "888-210-5799"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "812 N Imperial Ave",
            "address_purpose": "LOCATION",
            "city": "El Centro",
            "state": "CA",
            "postal_code": "922431916",
            "country_code": "US",
            "telephone_number": "760-352-7460",
            "fax_number": "888-210-5799",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "IMPERIAL BEACH OPTOMETRIC CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-01-25",
        "last_updated": "2025-07-03",
        "certification_date": "2025-07-03",
        "status": "A",
        "authorized_official_last_name": "TAM",
        "authorized_official_first_name": "MAY",
        "authorized_official_title_or_position": "IBOC VICE PRESIDENT",
        "authorized_official_telephone_number": "619-297-2020",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Optom-Eyes Vision Care",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Optom-Eyes Vision Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in San Diego, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 3, 2025; 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.