17TH STREET OPTOMETRY APC (NPI# 1891268678) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1891268678 |
| Entity Type | Organization |
| Organization Name | 17TH STREET OPTOMETRY APC |
| Practice Address |
17300 17th St Ste M Tustin CA 92780-1955 |
| Practice Telephone | 7148389664 |
| Practice Fax Number | 7148386774 |
| Mailing Telephone | 7148389664 |
| Mailing Fax Number | 7148386774 |
| Enumeration Date | 2019-01-04 |
| Last Update Date | 2019-01-04 |
| Authorized Official Name | ALEXANDER ELSON (OPTOMETRIST) |
| Authorized Official Telephone | 9493387027 |
| Authorized Official Credential | OD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 152WC0802X |
Optometrist Specialization: Corneal and Contact Management |
Eye and Vision Services Providers | ||
| N | 152WP0200X |
Optometrist Specialization: Pediatrics |
Eye and Vision Services Providers | ||
| N | 152WX0102X |
Optometrist Specialization: Occupational Vision |
Eye and Vision Services Providers | ||
| Y | 152W00000X | Optometrist | Eye and Vision Services Providers |
| Street Address |
17300 17TH ST STE M |
| City | TUSTIN |
| State | CA |
| Zip Code | 92780-1955 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295775047 | Karen Toki Wakayama | Optometrist | 17300 17th St Ste M, Tustin, CA 92780-1955 | 2006-06-08 |
| 1154452118 | Cynthia Broady | Optometrist | 17300 17th St Ste M, Tustin, CA 92780-1955 | 2007-03-08 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437780947 | John Michael Michael | Pharmacist | 14481 Wildeve Ln, Tustin, CA 92780 | 2020-02-03 |
| 1609426881 | Abigail Joy Maqsood | Behavior Technician | 290a S Prospect Ave, Tustin, CA 92780 | 2019-09-19 |
| 1255814711 | Hyun Dong Lee | Chiropractor | 14591 Newport Ave Ste 106, Tustin, CA 92780 | 2018-09-11 |
| 1346733573 | Elizabeth Kim Nguyen Dds Inc | Clinic/Center | 14521 Red Hill Ave, Tustin, CA 92780 | 2018-06-12 |
| 1255829503 | Hw Physical Therapy | Physical Therapist | 250 El Camino Real Ste 100, Tustin, CA 92780 | 2018-04-23 |
| 1912494352 | Gary Wayne Mcbeath | Marriage & Family Therapist | 17821 E 17th Street, Suite # 260, Tustin, CA 92780 | 2018-04-20 |
| 1104334598 | Catherine Bogues | Speech-Language Pathologist | 661 West 1st Street, Suite E, Tustin, CA 92780 | 2018-01-19 |
| 1972019941 | Lighthouse Behavioral Solutions | Behavioral Analyst | 18002 Irvine Blvd., Suite 202c, Tustin, CA 92780 | 2017-12-28 |
| 1629597299 | Lifecab, LLC | Non-emergency Medical Transport (VAN) | 13732 Newport Ave, Suite #1, Tustin, CA 92780 | 2017-09-14 |
| 1437606555 | Tustin Speech Therapy, Inc. | Speech-Language Pathologist | 661 West First Street, Suite E, Tustin, CA 92780 | 2016-09-07 |
| Find all providers in zip 92780 | ||||
| Taxonomy Code | 152W00000X |
| Grouping | Eye and Vision Services Providers |
| Classification | Optometrist |
| Doctors of optometry (ODs) are the primary health care professionals for the eye. Optometrists examine, diagnose, treat, and manage diseases, injuries, and disorders of the visual system, the eye, and associated structures as well as identify related systemic conditions affecting the eye. An optometrist has completed pre-professional undergraduate education in a college or university and four years of professional education at a college of optometry, leading to the doctor of optometry (O.D.) degree. Some optometrists complete an optional residency in a specific area of practice. Optometrists are eye health care professionals state-licensed to diagnose and treat diseases and disorders of the eye and visual system. |
| Notes: Source: American Optometric Association (AOA), approved by the AOA’s Board of Trustees, June 21, 2005. [7/1/2006: definition modified] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124411285 | Retina Institute of California Medical Group | Optometrist | 14642 Newport Ave Ste 350, Tustin, CA 92780-6091 | 2015-03-13 |
| 1396166773 | Dorothy Lea | Optometrist | 15529 Azalea Dr, Tustin, CA 92782-1901 | 2014-01-02 |
| 1801123518 | Cathy Ong | Optometrist | 15501 Sonora St, Tustin, CA 92782-1937 | 2009-11-17 |
| 1407011273 | Elizabeth K Chung | Optometrist | 2521 Michelle Dr, Tustin, CA 92780-7014 | 2008-07-22 |
| 1104037456 | Barbara Jean Villa | Optometrist | 2700 Park Avenue, Tustin, CA 92782 | 2007-05-25 |
| 1548487333 | Jennifer Lee Jensen | Optometrist | 17300 East 17th St, Suite M, Tustin, CA 92780 | 2007-04-20 |
| 1467578963 | Todd J Silverberg | Optometrist | 13257 Jamboree Rd, Tustin, CA 92782-9158 | 2007-03-22 |
| 1194878744 | Lulu Y Kim | Optometrist | 2530 Bryan Ave, Suite D, Tustin, CA 92782-8916 | 2007-01-18 |
| 1023189735 | Joshua Kaye | Optometrist | 17602 17th St Ste 103, Tustin, CA 92780-1961 | 2006-11-13 |
| 1023129939 | Lori Shim Yoo | Optometrist | 2831 Park Ave, Tustin, CA 92782-2711 | 2006-08-31 |
| Find all providers in TUSTIN | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.