Active NPI
Jonathan Pham, OD
- Optometrist
- Livermore, CA
National Provider Identifier
1821724873
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 34882
- Practice address
- 1800 Fourth St
Livermore, CA 94550-4454 - Phone
- (925) 447-3883
- NPI assigned
- Jul 30, 2022
- 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 | 34882 | CA | Primary |
Addresses
Primary practice location
1800 Fourth St
Livermore, CA 94550-4454
Mailing address
1666 Serpa Dr
Milpitas, CA 95035-4726
Phone (408) 806-6687
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
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Optometry
- Education
- Southern California College of Optometry, 2021
- Medicare assignment
- May accept Medicare assignment
- Group practices
Practice addresses (Care Compare)
1800 4TH St
Livermore, CA 94550-4454
Phone (925) 447-3883
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 34882 | CA | MD | Chiropractor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Livermore Optometry Group | Optometrist | Current | Accepting new patients |
Locations
1800 4th St
Livermore, CA 94550
Phone (925) 447-3883
Organizations & group practices 2
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.
-
- Optometrist
- Livermore, CA
- NPI 1114062635
-
- Optometrist
- Novato, CA
- NPI 1154207868
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1659139200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1659139200000",
"number": "1821724873",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1666 SERPA DR",
"city": "MILPITAS",
"state": "CA",
"postal_code": "950354726",
"telephone_number": "408-806-6687"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1800 FOURTH ST",
"city": "LIVERMORE",
"state": "CA",
"postal_code": "945504454",
"telephone_number": "925-447-3883"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PHAM",
"first_name": "JONATHAN",
"name_prefix": "Dr.",
"credential": "OD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2022-07-30",
"last_updated": "2022-07-30",
"certification_date": "2022-07-30",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "CA",
"license": "34882",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Livermore, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 30, 2022; 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.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.