Individual provider Active NPI

Poonam Virendra Nathu, O.D

  • Optometrist
  • Frisco, TX
National Provider Identifier
1912312430
Registry record updated Oct 6, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
8572T Issued in TX
Practice address
5253 Sylvan Shores Dr
Frisco, TX 75034-6411
Phone
(714) 651-6993
NPI assigned
Jun 23, 2014
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 6, 2014

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Vision Therapy Optometrist 152WV0400X 8572T TX
Pediatric Optometrist 152WP0200X 8572T TX
Optometrist 152W00000X 8572T TX Primary

Addresses

Primary practice location

5253 Sylvan Shores Dr
Frisco, TX 75034-6411

Mailing address

5253 Sylvan Shores Dr
Frisco, TX 75034-6411
Phone (714) 651-6993

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
I20180525001835 CA Practitioner - Optometry 1456660539 Reassigns benefits to 3 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
15204CAMDGeneral Practice Dentistry
8572TTXMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Lisa M. Weiss, O.D. Optometric Corp Pediatrics CurrentSince Jul 22, 2019 Accepting new patients
Total Vision PC Optometrist CurrentSince Jul 22, 2019 Accepting new patients
Steven T Klein OD & Kimberly Plattner OD a Professional Corporation Optometrist Past Accepting new patients
Sutter North Medical Foundation PastSince Feb 15, 2021 Accepting new patients

Locations

303 E Main St
El Cajon, CA 92020
Phone (619) 444-1153

27271 Las Ramblas
Ste 210
Mission Viejo, CA 92691

11717 Bernardo Plaza Ct
Ste 105
San Diego, CA 92128
Phone (858) 487-5555

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": "1403481600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1412553600000",
    "number": "1912312430",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5253 SYLVAN SHORES DR",
            "city": "FRISCO",
            "state": "TX",
            "postal_code": "750346411",
            "telephone_number": "714-651-6993"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5253 SYLVAN SHORES DR",
            "city": "FRISCO",
            "state": "TX",
            "postal_code": "750346411",
            "telephone_number": "714-651-6993"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NATHU",
        "first_name": "POONAM",
        "middle_name": "VIRENDRA",
        "name_prefix": "Dr.",
        "credential": "O.D",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-06-23",
        "last_updated": "2014-10-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152WV0400X",
            "taxonomy_group": "",
            "desc": "Optometrist, Vision Therapy",
            "state": "TX",
            "license": "8572T",
            "primary": false
        },
        {
            "code": "152WP0200X",
            "taxonomy_group": "",
            "desc": "Optometrist, Pediatrics",
            "state": "TX",
            "license": "8572T",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "TX",
            "license": "8572T",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Frisco, TX

Sources for this page

Verify at the official NPI Registry.