Individual provider Active NPI

Sam Lee, OD

  • Optometrist
  • Berkeley, CA
National Provider Identifier
1922779404
Registry record updated Apr 8, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
34986 Issued in CA
Practice address
3100 San Pablo Ave FL 4
Berkeley, CA 94702-2498
Phone
(415) 353-8299
NPI assigned
Sep 23, 2021
Last updated
Apr 8, 2025By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 8, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X 34986 CA Primary

Addresses

Primary practice location

3100 San Pablo Ave FL 4
Berkeley, CA 94702-2498

Mailing address

17806 Sycamore Ave
Patterson, CA 95363-9336

Other practice location 1

230 Minor Hall Mc-2020
Berkeley, CA 94720-0001
Phone (510) 642-2020

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
I20211027003257 CA Practitioner - Optometry 0143618934 Reassigns benefits to 5 organizations

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
State University of New York - State College Optometry, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Regents of the University of California at BerkeleyGroup PAC ID 8628083110, 57 clinicians

Practice addresses (Care Compare)

200 Minor Hall
Suite 384a
Berkeley, CA 94720-2020
Phone (510) 642-2020

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
34986CAMDLicensed Psychiatric Technician

Practice roles

OrganizationSpecialtyStatusNew patients
Alameda Health System Single Specialty CurrentSince May 31, 2024 Accepting new patients
UCSF Medical Group Business Services CurrentSince Mar 28, 2024 Accepting new patients
Regents of the University of California at Berkeley Optometrist CurrentSince Oct 1, 2021 Accepting new patients
Mendocino Community Health Clinic, Inc. CurrentSince Mar 1, 2023 Accepting new patients
UCSF Medical Group Business Services Single Specialty CurrentSince Mar 28, 2024 Accepting new patients
Alameda Health System Single Specialty CurrentSince May 31, 2024 Accepting new patients
Mendocino Community Health Clinic, Inc. Single Specialty Current Accepting new patients
University of California San Francisco CurrentSince Mar 28, 2024 Accepting new patients
Alameda Health System Single Specialty Current Accepting new patients
Mendocino Community Health Clinic, Inc. CurrentSince Mar 1, 2023 Accepting new patients
University of California San Francisco Single Specialty CurrentSince Mar 28, 2024 Accepting new patients
University of California San Francisco Medical Center Past Accepting new patients
University of California San Francisco Past Accepting new patients

Locations

200 Minor Hall
Ste 384A
Berkeley, CA 94720
Phone (510) 642-7844

3100 San Pablo Ave
Berkeley, CA 94702
Phone (510) 985-5020

3100 San Pablo Ave
Fl 4
Berkeley, CA 94702
Phone (415) 353-8299

664 Southland Mall
Hayward, CA 94545
Phone (510) 266-1700

6955 Foothill Blvd
Ste 200
Oakland, CA 94605
Phone (510) 567-5700

2330 Post St
San Francisco, CA 94115
Phone (415) 502-4444

400 Parnassus Ave
#A632
San Francisco, CA 94143
Phone (415) 473-1000

333 Laws Ave
Ukiah, CA 95482
Phone (707) 463-1113

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

  • Direct secure messaging: sam.lee.1@28334.direct.athenahealth.com
  • Direct secure messaging: slee188530@direct-ucsfmedicalcenter.org

Organizations & group practices 13

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.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1632355200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1744070400000",
    "number": "1922779404",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17806 SYCAMORE AVE",
            "city": "PATTERSON",
            "state": "CA",
            "postal_code": "953639336"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3100 SAN PABLO AVE FL 4",
            "city": "BERKELEY",
            "state": "CA",
            "postal_code": "947022498",
            "telephone_number": "415-353-8299"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "230 Minor Hall Mc-2020",
            "address_purpose": "LOCATION",
            "city": "Berkeley",
            "state": "CA",
            "postal_code": "947200001",
            "country_code": "US",
            "telephone_number": "510-642-2020",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LEE",
        "first_name": "SAM",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-09-23",
        "last_updated": "2025-04-08",
        "certification_date": "2025-04-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "CA",
            "license": "34986",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Berkeley, CA

Sources for this page

Verify at the official NPI Registry.