Individual provider Active NPI

Tracy Wong, O.D.

  • Optometrist
  • El Segundo, CA
National Provider Identifier
1821177239
Registry record updated Feb 12, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
12873 T Issued in CA
Practice address
2101 Rosecrans Ave
El Segundo, CA 90245-4749
Phone
(310) 321-6990
NPI assigned
Nov 4, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 12, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 12873 T CA Primary

Addresses

Primary practice location

2101 Rosecrans Ave
El Segundo, CA 90245-4749

Mailing address

2101 Rosecrans Ave
El Segundo, CA 90245-4749
Phone (310) 321-6990

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
I20090930000110 CA Practitioner - Optometry 3779629092 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Southern California College of Optometry, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Marsha Howard Optometric CorpGroup PAC ID 5294114021, 6 clinicians

Practice addresses (Care Compare)

2200 E Willow St
Signal Hill, CA 90755-2132
Phone (562) 427-8285

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
12873CAMDCounselor
12873 TCAMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Marsha Howard Optometric Corp Optometrist CurrentSince Oct 1, 2022 Accepting new patients
Morton Optometric Inc Optometrist PastSince Mar 1, 2015 Accepting new patients
Stephen R. Keller, O.D., Inc. Optometrist PastSince Dec 19, 2012 Accepting new patients
Keller Optometric, Inc. Optometrist PastSince Aug 11, 2015 Accepting new patients

Locations

2200 E Willow St
Signal Hill, CA 90755
Phone (562) 424-2837

Organizations & group practices 4

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": "1162598400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1392163200000",
    "number": "1821177239",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2101 ROSECRANS AVE",
            "city": "EL SEGUNDO",
            "state": "CA",
            "postal_code": "902454749",
            "telephone_number": "310-321-6990"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2101 ROSECRANS AVE",
            "city": "EL SEGUNDO",
            "state": "CA",
            "postal_code": "902454749",
            "telephone_number": "310-321-6990"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WONG",
        "first_name": "TRACY",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-04",
        "last_updated": "2014-02-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "12873 T",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in El Segundo, CA

Sources for this page

Verify at the official NPI Registry.