Visaka Dianna Inthavong, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

35045 Issued in CA

Practice address

305 Pollasky Ave
Clovis, CA 93612-1139

Phone

(559) 298-2120

NPI assigned

Oct 13, 2021

Last updated

Aug 13, 2024By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Dr. Dianna Inthavong Other name

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

Specialty

Optometry

Education

Other, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Susan D Mencarini & Jay a Newsome

  • Optometrist
  • Clovis, CA
  • NPI 1265642664
  Medicare reassignment NPD
• Steven W Shute O D Inc

  • Eyewear Supplier
  • Clovis, CA
  • NPI 1649593021

  Optometrist

  NPD

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

{
    "created_epoch": "1634083200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1723507200000",
    "number": "1831851120",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "305 POLLASKY AVE",
            "city": "CLOVIS",
            "state": "CA",
            "postal_code": "936121139",
            "telephone_number": "559-298-2120"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "305 POLLASKY AVE",
            "city": "CLOVIS",
            "state": "CA",
            "postal_code": "936121139",
            "telephone_number": "559-298-2120"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "INTHAVONG",
        "first_name": "VISAKA",
        "middle_name": "DIANNA",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-10-13",
        "last_updated": "2024-08-13",
        "certification_date": "2024-08-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "35045",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "DIANNA",
            "last_name": "INTHAVONG",
            "prefix": "DR.",
            "credential": "OD",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Steve Daniel Inouye, PHARM.D.
• Woon Inouye
• Insight Diagnostics Inc
• Integrity Lab Solutions (Dynacare Diagnostic)
• Integrity Medical Group Corp
• Cory Ipsen, PA-C
• Erika Lezann Ireland, RDN
• Alan Todd Israel, O.D.
• J. a. Mirelez Jr DDS Inc. (Mirelez Revitalize Dental Implant Center)
• Sara Jamal Jaber

• Optometrist in Clovis, CA
• Providers in Clovis, CA by specialty
• Optometrist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 13, 2024; 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.

Verify at the official NPI Registry.