Individual provider Active NPI

Charles S Lee, O.D.

  • Optometrist
  • Bakersfield, CA
National Provider Identifier
1932592763
Registry record updated Dec 6, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
15373 Issued in CA
Practice address
9000 Ming Ave
Suite L1B
Bakersfield, CA 93311-1318
Phone
(661) 664-3314
NPI assigned
Mar 18, 2015
Last updated
Dec 6, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 6, 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 15373 CA Primary

Addresses

Primary practice location

9000 Ming Ave
Suite L1B
Bakersfield, CA 93311-1318

Mailing address

1100 Mondavi Way
Unit B4
Bakersfield, CA 93312-4346
Phone (323) 717-6046

Electronic endpoints 1

TypeEndpointUseAffiliation
SOAP URL https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq Health Information Exchange (HIE) Southern California Permanente Medical Group

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
I20161020000099 CA Practitioner - Optometry 1951699248 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Southern California College of Optometry, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

3733 San Dimas St
Suite 101
Bakersfield, CA 93301-1407
Phone (800) 353-5400

9000 Ming Ave
Suite L 1B
Bakersfield, CA 93311-1318
Phone (877) 524-7373

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
15373CAMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Southern California Permanente Medical Group CurrentSince Sep 12, 2016 Accepting new patients
Southern California Permanente Medical Group Current Accepting new patients
Southern California Permanente Medical Group CurrentSince Sep 12, 2016 Accepting new patients

Locations

3733 San Dimas St
Bakersfield, CA 93301
Phone (661) 631-3008

3733 San Dimas St
Ste 101
Bakersfield, CA 93301
Phone (800) 353-5400

9000 Ming Ave
Ste L1B
Bakersfield, CA 93311
Phone (661) 664-3314

393 E Walnut St
Unit 3RD
Pasadena, CA 91188
Phone (626) 405-7914

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1426636800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1638748800000",
    "number": "1932592763",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1100 MONDAVI WAY",
            "address_2": "UNIT B4",
            "city": "BAKERSFIELD",
            "state": "CA",
            "postal_code": "933124346",
            "telephone_number": "323-717-6046"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9000 MING AVE",
            "address_2": "SUITE L1B",
            "city": "BAKERSFIELD",
            "state": "CA",
            "postal_code": "933111318",
            "telephone_number": "661-664-3314"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LEE",
        "first_name": "CHARLES",
        "middle_name": "S",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-03-18",
        "last_updated": "2021-12-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "15373",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq",
            "affiliation": "Y",
            "endpointDescription": "Carequality",
            "affiliationName": "Southern California Permanente Medical Group",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "3733 San Dimas St",
            "city": "Bakersfield",
            "state": "CA",
            "country_code": "US",
            "postal_code": "933011407",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Bakersfield, CA

Sources for this page

Verify at the official NPI Registry.