Individual provider Active NPI

Xu Shao Huang, O.D.

  • Optometrist
  • Yucca Valley, CA
National Provider Identifier
1851495550
Registry record updated Oct 15, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
13213 T Issued in CA
Practice address
56970 Yucca TRL Ste 101
Yucca Valley, CA 92284-7911
Phone
(760) 228-2020
Fax
(760) 369-2020
NPI assigned
Sep 12, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 15, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 13213 T CA Primary

Addresses

Primary practice location

56970 Yucca TRL Ste 101
Yucca Valley, CA 92284-7911

Mailing address

56970 Yucca TRL
Ste 101
Yucca Valley, CA 92284-7911
Phone (760) 228-2020

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
I20100105000116 CA Practitioner - Optometry 4880618248 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
University of California - School of Optometry, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Clarion Optometry Group Prof CorpGroup PAC ID 0042538464, 4 clinicians
Desert Eye Associates a Professional CorporationGroup PAC ID 4880969351, 5 clinicians

Practice addresses (Care Compare)

56970 Yucca TRL
Suite 101
Yucca Valley, CA 92284-7911
Phone (760) 228-2020

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as individual

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
13213 TCAMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Clarion Optometry Group Prof Corp Optometrist CurrentSince Oct 16, 2014 Accepting new patients
Athena Brasfield OD a Professional Corporation Optometrist Past Accepting new patients

Locations

42625 Jackson St
Indio, CA 92203
Phone (760) 342-5800

3658 S Nogales St
West Covina, CA 91792
Phone (626) 461-7300

56970 Yucca Trl
Ste 101
Yucca Valley, CA 92284
Phone (760) 228-2020

56970 Yucca Trl
Ste 103
Yucca Valley, CA 92284
Phone (760) 365-9878

Interoperability endpoints

  • Direct secure messaging: drhuang@clarionoptometry.direct.eyemdemr.com

Organizations & group practices 3

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": "1158019200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1602720000000",
    "number": "1851495550",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "56970 YUCCA TRL",
            "address_2": "STE 101",
            "city": "YUCCA VALLEY",
            "state": "CA",
            "postal_code": "922847911",
            "telephone_number": "760-228-2020"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "56970 YUCCA TRL STE 101",
            "city": "YUCCA VALLEY",
            "state": "CA",
            "postal_code": "922847911",
            "telephone_number": "760-228-2020",
            "fax_number": "760-369-2020"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HUANG",
        "first_name": "XU SHAO",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-12",
        "last_updated": "2020-10-15",
        "certification_date": "2020-10-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "13213 T",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Yucca Valley, CA

Sources for this page

Verify at the official NPI Registry.