Jessica Polak, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

35309 Issued in CA

Practice address

2500 E Imperial Hwy Ste 196
Brea, CA 92821-6121

Phone

(657) 439-5750

NPI assigned

Sep 15, 2022

Sex

Female

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

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 and National Provider Directory roles.

• Tedder Optometric Corporation, PC

  • Optometrist
  • Lake Forest, CA
  • NPI 1679262158
  Medicare reassignment NPD
• Hansra Optometric Corporation

  • Eyewear Supplier
  • Sacramento, CA
  • NPI 1366258436
  NPD

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

{
    "created_epoch": "1663200000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1695513600000",
    "number": "1962124016",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2500 E IMPERIAL HWY STE 196",
            "city": "BREA",
            "state": "CA",
            "postal_code": "928216121",
            "telephone_number": "657-439-5750"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2500 E IMPERIAL HWY STE 196",
            "city": "BREA",
            "state": "CA",
            "postal_code": "928216121",
            "telephone_number": "657-439-5750"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POLAK",
        "first_name": "JESSICA",
        "name_prefix": "Ms.",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-09-15",
        "last_updated": "2023-09-24",
        "certification_date": "2023-09-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "35309",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Francisco Pinto
• Pious Hospice and Palliative Care Inc
• Ashley Pirir
• Kimberlee Thanh-Tran Ployngam
• Amanda Pohlen
• Julia Polanco, PT, DPT
• Precision Pharmacy Center, LLC
• Premier Covid Testing Inc
• Premier Medical Transport, Inc.
• Timothy Michael Prior, M.S. LMFT, BCBA

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 24, 2023; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.