Individual provider Active NPI

Bridget Joy Leesang, O.D.

  • Optometrist
  • San Antonio, TX
National Provider Identifier
1902886898
Registry record updated Oct 20, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
5136TG Issued in TX
Practice address
22906 US Highway 281 N
San Antonio, TX 78258-7632
Phone
(210) 495-7483
Fax
(210) 497-1206
NPI assigned
Jan 18, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 20, 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 5136TG TX Primary

Addresses

Primary practice location

22906 US Highway 281 N
San Antonio, TX 78258-7632

Mailing address

1950 Old Gallows Rd Ste 520
Vienna, VA 22182-3970
Phone (703) 847-8899

Other identifiers 1

IdentifierTypeStateIssuer
019416901MedicaidTX

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
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
I20040826000008 TX Practitioner - Optometry 6608846308 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
University of Houston - College of Optometry, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Med Southwest PLLCGroup PAC ID 4082952874, 234 clinicians

Practice addresses (Care Compare)

255 E Basse Rd
Suite 330
San Antonio, TX 78209-8343
Phone (210) 308-8565

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
5136TGTXMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Med Southwest, PLLC Optometrist CurrentSince Nov 29, 2021 Accepting new patients
Med Southwest, PLLC Optometrist Current Accepting new patients
Med Southwest, PLLC Optometrist CurrentSince Nov 29, 2021 Accepting new patients
Bridget Leesang OD Optometrist PastSince Jan 1, 1990 Accepting new patients
Silver Spring Optometry, LLC Optometrist Past Accepting new patients

Locations

4437 De Zavala Rd
#A
San Antonio, TX 78249
Phone (210) 492-7483

22906 US Highway 281 N
Ste 101
San Antonio, TX 78258
Phone (210) 492-7483

255 E Basse Rd
Ste 330
San Antonio, TX 78209
Phone (210) 308-8565

2703 Richmond Rd
Texarkana, TX 75503
Phone (903) 838-0783

1950 Old Gallows Rd
Ste 520
Vienna, VA 22182

Organizations & group practices 5

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": "1137542400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1634688000000",
    "number": "1902886898",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1950 OLD GALLOWS RD STE 520",
            "city": "VIENNA",
            "state": "VA",
            "postal_code": "221823970",
            "telephone_number": "703-847-8899",
            "fax_number": "571-223-6780"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22906 US HIGHWAY 281 N",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782587632",
            "telephone_number": "210-495-7483",
            "fax_number": "210-497-1206"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LEESANG",
        "first_name": "BRIDGET",
        "middle_name": "JOY",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-01-18",
        "last_updated": "2021-10-20",
        "certification_date": "2021-10-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "TX",
            "license": "5136TG",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "019416901",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in San Antonio, TX

Sources for this page

Verify at the official NPI Registry.