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CHARLES E DOMINGUEZ O.D.
NPI 1063437507
Optometrist in Lake Forest, CA

Active since July 13, 2006PECOS Enrolled
21098 BAKE PKWY, SUITE 110, LAKE FOREST, CA 92630(949) 597-0104 Get Directions Write a Review

NPPES record last updated: October 15, 2014. Verified against the NPPES registry weekly; last sync: October 18, 2026.

About Charles E Dominguez O.d. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

CHARLES E DOMINGUEZ O.D. (NPI 1063437507) is an individual optometrist in Lake Forest, California, licensed in California (OPT 12292 TPA) and active in the NPI registry since July 2006. He is enrolled in Medicare PECOS and is a graduate of University Of California, Geffen School Of Medicine (2003).

NPPES Registry Identity

NPI1063437507
Entity TypeIndividualMale
Primary Taxonomy152W00000X
Provider Legal NameCHARLES E DOMINGUEZCredential: O.D.
Location Address21098 BAKE PKWY, SUITE 110Lake Forest, CA 92630-2163
Mailing Address21098 Bake Pkwy, Suite 110Lake Forest, CA 92630-2163 · (949) 597-0104
Phone(949) 597-0104
Sole ProprietorNo
Medical School CMSUniversity Of California, Geffen School Of MedicineGraduated 2003
Enumeration DateJuly 13, 2006
Last NPPES UpdateOctober 15, 2014
✔ NPI 1063437507 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyOptometristEye and Vision Services Providers
Taxonomy Code152W00000X
License✔ Licensed in CA · OPT 12292 TPA
Definition
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.
21098 BAKE PKWY, Lake Forest, CA 92630
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Other Identifiers 8

Medicare NSC0610180004
Medicare UPINU96994CA
Medicare PINP01349077CA
Medicare NSC0610180001
Medicare NSC0610180005
Medicare PINFA894PCA
Medicare NSC0610180003
Medicare NSC0610180002

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Anthem Blue Cross and Blue Shield, Blue Cross and Blue Shield of Louisiana, Blue Cross and Blue Shield of Montana and more.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Charles E Dominguez O.d. is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

PECOS PAC ID6800817875
PECOS Enrollment IDI20051219000329
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignments

2

Medicare enrollment records show Charles Dominguez reassigns Medicare billing to 2 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.

Dominguez Alderson Optometric Inc
Same address
Optometrist
21098 BAKE PKWY, SUITE 110
Lake Forest, CA 92630
  • Reassigned Medicare billing, California enrollment
  • 2 clinicians in this Medicare group
NPI 1922399864 (949) 597-0104
De La Pena Eye Clinic, A Medical Group, Inc
11 mi
Ophthalmology
1520 N GRAND AVE
Santa Ana, CA 92701
  • Reassigned Medicare billing, California enrollment
  • 36 clinicians in this Medicare group
NPI 1831536481 (714) 558-1385

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Areas of Expertise CMS Part B claims 5

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more 99213
This is a routine visit for patients who have already been seen by the healthcare provider. During this approximately 20-29 minute appointment, your health status will be evaluated and any necessary treatments or tests will be discussed. It's a chance to address any health concerns you may have.
47 services38 patients
Photography of the retina 92250
Photography of the retina, also known as retinal imaging, is a non-invasive procedure that captures images of the back of your eye. This helps doctors identify and monitor conditions like glaucoma, macular degeneration, or diabetic retinopathy. It's painless and quick, often part of a routine eye exam.
41 services35 patients
Exam of visual field with extended testing 92083
An extended visual field exam is a detailed test to evaluate your peripheral (side) vision. It helps to detect any potential blind spots which may not be noticeable in daily life. These could be caused by eye diseases like glaucoma, or neurological conditions.
35 services33 patients
Exam of the internal drainage system of eye 92020
This is a procedure where your doctor examines the eye's internal drainage system, essential for maintaining eye pressure. They use specialized tools to check for blockages or damage that might lead to conditions like glaucoma. It's non-invasive and painless.
34 services30 patients
Established patient complete exam of visual system 92014
An established patient complete exam of the visual system involves a thorough check of your eyes and vision. It assesses eye health, checks for diseases, and measures your ability to see clearly at different distances. It's a routine, non-invasive procedure.
27 services26 patients

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 92630 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$142.39 typical visit price
range $62.96 – $187.60
Typical copayment $35.59 (range $15.74 – $46.90)
Most-billed visit code 99204
Established Patient
$77.96 typical visit price
range $20.84 – $153.61
Typical copayment $19.49 (range $5.21 – $38.40)
Most-billed visit code 99213
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 3

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

CHERYL EVELYN ALDERSON O.D.
Optometrist
21098 BAKE PKWY, SUITE 110
LAKE FOREST, CA 92630
Orange County (949) 597-0104
COLLEEN HANNEGAN RDO
Technician/Technologist (Optician)
21098 BAKE PKWY, SUITE 110
LAKE FOREST, CA 92630
Orange County (949) 597-0104
DOMINGUEZ ALDERSON OPTOMETRIC INC
Optometrist
21098 BAKE PKWY, SUITE 110
LAKE FOREST, CA 92630
Orange County (949) 597-0104

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Charles Dominguez's NPI number?

The NPI number for Charles Dominguez is 1063437507. It was assigned to this individual provider in the NPPES registry on July 13, 2006.

Where is Charles Dominguez located?

Charles Dominguez practices at 21098 Bake Pkwy Suite 110, Lake Forest, CA 92630. The listed phone number is (949) 597-0104.

What is Charles Dominguez's specialty?

The primary specialty registered for this NPI is Optometrist with taxonomy code 152W00000X.

Is Charles Dominguez enrolled in Medicare?

Yes. Charles Dominguez is registered in the Medicare PECOS enrollment system.

Which organizations bill Medicare for Charles Dominguez's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Charles Dominguez reassigns Medicare benefits to 2 organizations: Dominguez Alderson Optometric Inc (Lake Forest, CA) and De La Pena Eye Clinic, A Medical Group, Inc (Santa Ana, CA). Each reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Charles Dominguez's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

What insurance does Charles Dominguez accept?

Health plans from Anthem Blue Cross and Blue Shield, Blue Cross Blue Shield of Wyoming, Blue Cross and Blue Shield of Louisiana, Blue Cross and Blue Shield of Montana and Blue Cross and Blue Shield of Oklahoma and 2 other insurers list Charles Dominguez as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Charles Dominguez was last updated on October 15, 2014. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 12 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.