Nicole Jae Sim Optometric, Inc

Primary specialty

OptometristTaxonomy code 152W00000X

License

11438TPA Issued in CA

Legal business name

NICOLE JAE SIM OPTOMETRIC, INC

Doing business as

Walnut Square Optometry

Practice address

2118 Vine St
Suite E
Berkeley, CA 94709-1524

Phone

(510) 548-3947

Fax

(510) 548-3501

NPI assigned

Jan 7, 2010

Organization subpart

Yes

Parent organization

NICOLE JAE SIM OPTOMETRIC, INCAs reported in NPPES

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

Authorized official

Name

Dr. Nicole Jae Sim, O.D.NPI 1861577744

Title

President

Phone

(510) 548-3947

Specialties & licenses 1

Addresses

Other names 1

• Walnut Square Optometry Doing business as

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Part of

Walnut Square Optometry

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Nicole Jae Sim, O.D.

  • Optometrist
  • Berkeley, CA
  • NPI 1861577744
  Medicare reassignment NPD Authorized official
• Angela Joy Cheung, O.D.

  • Corneal and Contact Management Optometrist
  • Oakland, CA
  • NPI 1346658184
  Medicare reassignment NPD

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

{
    "created_epoch": "1262822400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1264723200000",
    "number": "1932439304",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2118 VINE ST",
            "address_2": "SUITE E",
            "city": "BERKELEY",
            "state": "CA",
            "postal_code": "947091524",
            "telephone_number": "510-548-3947",
            "fax_number": "510-548-3501"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2118 VINE ST",
            "address_2": "SUITE E",
            "city": "BERKELEY",
            "state": "CA",
            "postal_code": "947091524",
            "telephone_number": "510-548-3947",
            "fax_number": "510-548-3501"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NICOLE JAE SIM OPTOMETRIC, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "NICOLE JAE SIM OPTOMETRIC, INC",
        "enumeration_date": "2010-01-07",
        "last_updated": "2010-01-29",
        "status": "A",
        "authorized_official_last_name": "SIM",
        "authorized_official_first_name": "NICOLE",
        "authorized_official_middle_name": "JAE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "510-548-3947",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "CA",
            "license": "11438TPA",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Walnut Square Optometry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Aliyah Nandi Nichols
• Camille Nichols, MFT
• James Arthur Nickelsen, M.D.
• Julie Anne Nickelsen, MD
• Ryan Nicolas
• Nicole Laby, MFT
• Nicole Melwani, Mot/L
• Megan Marie Nielsen, L.AC.
• Rebecca Nieves-McGoldrick
• Jamila Nightingale, LCSW

• Optometrist in Berkeley, CA
• Providers in Berkeley, CA by specialty
• Optometrist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 29, 2010; 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.