Individual provider Active NPI

Jessica Yuan, O.D.

  • Optometrist
  • Upland, CA
National Provider Identifier
1881639441
Registry record updated Dec 17, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
10945 Issued in CA
Practice address
1183 E Foothill Blvd
#140
Upland, CA 91786-4049
Phone
(909) 608-0601
Fax
(909) 608-0610
NPI assigned
Jun 18, 2006
Last updated
Dec 17, 2008By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 17, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 10945 CA Primary

Addresses

Primary practice location

1183 E Foothill Blvd
#140
Upland, CA 91786-4049

Mailing address

1183 E Foothill Blvd
#140
Upland, CA 91786-4049
Phone (909) 608-0601

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
I20080506000866 CA Practitioner - Optometry 0244319937 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Southern California College of Optometry, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

1183 E Foothill Blvd
Suite 140
Upland, CA 91786-4080
Phone (909) 608-0601

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
10945CAMDPhysical Therapy Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Rainbow Optometry,Inc. Optometrist CurrentSince Jun 1, 2007 Accepting new patients

Locations

1183 E Foothill Blvd
Ste 140
Upland, CA 91786
Phone (909) 608-0601

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1150588800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1229472000000",
    "number": "1881639441",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1183 E FOOTHILL BLVD",
            "address_2": "#140",
            "city": "UPLAND",
            "state": "CA",
            "postal_code": "917864049",
            "telephone_number": "909-608-0601",
            "fax_number": "909-608-0610"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1183 E FOOTHILL BLVD",
            "address_2": "#140",
            "city": "UPLAND",
            "state": "CA",
            "postal_code": "917864049",
            "telephone_number": "909-608-0601",
            "fax_number": "909-608-0610"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "YUAN",
        "first_name": "JESSICA",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-18",
        "last_updated": "2008-12-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "10945",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Upland, CA

Sources for this page

Verify at the official NPI Registry.