Individual provider Active NPI

Jessica Ngoc Vu, OD

  • Optometrist
  • Fresno, CA
National Provider Identifier
1861065260
Registry record updated Jul 22, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
34852 Issued in CA
Practice address
20 W Shaw Ave
Fresno, CA 93704-2816
Phone
(559) 222-0220
NPI assigned
Jul 22, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 22, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 34852 CA Primary

Addresses

Primary practice location

20 W Shaw Ave
Fresno, CA 93704-2816

Mailing address

9221 Houston Ave
Anaheim, CA 92801-1411
Phone (714) 473-4857

Other identifiers 1

IdentifierTypeStateIssuer
34852OtherCASTATE BOARD OF OPTOMETRY

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
I20220425002465 CA Practitioner - Optometry 6507253366 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Fyidoctors of California IncGroup PAC ID 3577961572, 21 clinicians

Practice addresses (Care Compare)

1039 El Monte Ave
Suite K
Mountain View, CA 94040-2371
Phone (650) 967-0140

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
34852CAMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Brent P. Chinn, OD and David M. Redman, OD, Optometric Group, Inc Optometrist CurrentSince Apr 1, 2022 Accepting new patients
Fyidoctors of California, Inc. Optometrist CurrentSince Apr 1, 2022 Accepting new patients
North Lake Eyecare Optometry Optometrist PastSince Apr 8, 2014 Accepting new patients

Locations

1039 El Monte Ave
Ste K
Mountain View, CA 94040
Phone (650) 967-0140

114 N Sunrise Ave
Ste C4
Roseville, CA 95661
Phone (916) 786-2212

117 Bernal Rd
Ste 40
San Jose, CA 95119
Phone (408) 362-9789

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": "1626912000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1626912000000",
    "number": "1861065260",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9221 HOUSTON AVE",
            "city": "ANAHEIM",
            "state": "CA",
            "postal_code": "928011411",
            "telephone_number": "714-473-4857"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20 W SHAW AVE",
            "city": "FRESNO",
            "state": "CA",
            "postal_code": "937042816",
            "telephone_number": "559-222-0220"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VU",
        "first_name": "JESSICA",
        "middle_name": "NGOC",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-07-22",
        "last_updated": "2021-07-22",
        "certification_date": "2021-07-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "34852",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE BOARD OF OPTOMETRY",
            "identifier": "34852",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fresno, CA

Sources for this page

Verify at the official NPI Registry.