NPIMap

Organization Active NPI

Woodbridge Optometry, Inc.

Doing business as Woodbridge Optometry

  • Optometrist
  • Irvine, CA
National Provider Identifier
1891232096
Registry record updated Feb 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
9377TPL Issued in CA
Legal business name
WOODBRIDGE OPTOMETRY, INC.
Doing business as
Woodbridge Optometry
Practice address
4505 Barranca Pkwy
Suite C
Irvine, CA 92604-4707
Phone
(949) 857-0676
Fax
(949) 857-2175
NPI assigned
Jan 25, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 22, 2020

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

Authorized official

Name
Dr. Alissa Sue Wald, ODNPI 1720132251
Title
Owner
Phone
(949) 857-0676

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X 9377TPL CA Primary

Addresses

Primary practice location

4505 Barranca Pkwy
Suite C
Irvine, CA 92604-4707

Mailing address

4505 Barranca Pkwy
Suite C
Irvine, CA 92604-4707
Phone (949) 857-0676

Other names 1

  • Woodbridge Optometry Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170322002049 CA Part B Supplier - Clinic/Group Practice 6901181510 Receives reassigned benefits from 12 practitioners
Practice locations: Irvine, CA

National Provider Directory

National Provider Directory

Locations

1545 Adams Ave
Ste 100
Costa Mesa, CA 92626
Phone (714) 545-9162

Practitioners & affiliated clinicians

Practitioners 12

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1485302400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1582329600000",
    "number": "1891232096",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4505 BARRANCA PKWY",
            "address_2": "SUITE C",
            "city": "IRVINE",
            "state": "CA",
            "postal_code": "926044707",
            "telephone_number": "949-857-0676",
            "fax_number": "949-857-2175"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4505 BARRANCA PKWY",
            "address_2": "SUITE C",
            "city": "IRVINE",
            "state": "CA",
            "postal_code": "926044707",
            "telephone_number": "949-857-0676",
            "fax_number": "949-857-2175"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WOODBRIDGE OPTOMETRY, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-01-25",
        "last_updated": "2020-02-22",
        "certification_date": "2020-02-22",
        "status": "A",
        "authorized_official_last_name": "WALD",
        "authorized_official_first_name": "ALISSA",
        "authorized_official_middle_name": "SUE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "949-857-0676",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "CA",
            "license": "9377TPL",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Woodbridge Optometry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Irvine, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.