Justin Tadashi Abo, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

11100T Issued in CA

Practice address

12759 Foothill Blvd
Ste C
Rancho Cucamonga, CA 91739-9336

Phone

(909) 899-0026

Fax

(909) 899-6381

NPI assigned

Dec 13, 2005

Last updated

Jun 19, 2014By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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

Specialty

Optometry

Education

Southern California College of Optometry, 1999

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Justin T Abo O D a Professional Corporation

  dba Foothill Optometric Center

  • Optometrist
  • Rancho Cucamonga, CA
  • NPI 1588771380
  Medicare reassignment NPD Authorized official
• Justin T. Abo, O.D.

  dba Foothill Optometric Center

  • Optometrist
  • Rancho Cucamonga, CA
  • NPI 1508944711
  NPD (past) Authorized official

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

{
    "created_epoch": "1134432000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1403136000000",
    "number": "1952386963",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12759 FOOTHILL BLVD",
            "address_2": "STE C",
            "city": "RANCHO CUCAMONGA",
            "state": "CA",
            "postal_code": "917399336",
            "telephone_number": "909-899-0026",
            "fax_number": "909-899-6381"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12759 FOOTHILL BLVD",
            "address_2": "STE C",
            "city": "RANCHO CUCAMONGA",
            "state": "CA",
            "postal_code": "917399336",
            "telephone_number": "909-899-0026",
            "fax_number": "909-899-6381"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ABO",
        "first_name": "JUSTIN",
        "middle_name": "TADASHI",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-13",
        "last_updated": "2014-06-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "11100T",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Joshua Abney
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• Optometrist in Rancho Cucamonga, CA
• Providers in Rancho Cucamonga, CA by specialty
• Optometrist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 19, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.