SOUTH PASADENA OPTOMETRIC GROUP, INC.
NPI 1750416566
Optometrist in South Pasadena, CA
About South Pasadena Optometric Group, Inc. NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
SOUTH PASADENA OPTOMETRIC GROUP, INC. (NPI 1750416566) is a healthcare organization registered as an optometrist in South Pasadena, California and active in the NPI registry since February 2007. The organization lists Annie Chen Lee Kim, Optometrist, as its authorized official.
NPPES Registry Identity
Specialties & Licenses
Group Practice 1
Medicare Participation & PECOS CMS
Medicare enrollment, revalidation and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
South Pasadena Optometric Group, Inc. is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Medicare Revalidation Due Date
Revalidation due by February 28, 2027
Medicare-enrolled providers and suppliers confirm their enrollment information with CMS on a set cycle, every 5 years for most and every 3 years for medical equipment suppliers. CMS sets the due date for each enrollment.
Clinicians Billing Medicare Through This Organization
8Medicare enrollment records show 8 clinicians reassign Medicare billing to South Pasadena Optometric Group, Inc., which bills Medicare for the services they deliver. Of these, 4 practice at this address and 6 within 10 miles. They are listed nearest first.
Clinicians, nearest first (8)
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
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 South Pasadena Optometric Group, Inc.'s NPI number?
The NPI number for South Pasadena Optometric Group, Inc. is 1750416566. It was assigned to this organization in the NPPES registry on February 22, 2007.
Where is South Pasadena Optometric Group, Inc. located?
South Pasadena Optometric Group, Inc. is located at 729 Mission St Ste 200, South Pasadena, CA 91030. The listed phone number is (626) 441-5300.
What is South Pasadena Optometric Group, Inc.'s specialty?
The primary specialty registered for this NPI is Optometrist with taxonomy code 152W00000X.
Is South Pasadena Optometric Group, Inc. enrolled in Medicare?
Yes. South Pasadena Optometric Group, Inc. is registered in the Medicare PECOS enrollment system.
When is South Pasadena Optometric Group, Inc.'s Medicare revalidation due?
According to the CMS Revalidation Due Date List (October 2026 release), the Medicare Non-DME Part B enrollment for this organization (California, Clinic/Group Practice) is due for revalidation by February 28, 2027. Medicare providers and suppliers revalidate their enrollment every 5 years, and medical equipment suppliers every 3 years. Confirm current requirements with your Medicare Administrative Contractor.
How many clinicians bill Medicare through South Pasadena Optometric Group, Inc.?
According to the CMS Revalidation Reassignment List (October 2026 release), 8 clinicians, all in Optometry, reassign their Medicare billing to South Pasadena Optometric Group, Inc.. A 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 the clinician's services. Of these, 4 practice at this address and 6 within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
When was this NPI record last updated?
The NPPES record for South Pasadena Optometric Group, Inc. was last updated on December 21, 2018. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 7 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.
# South Pasadena Optometric Group, Inc. · NPI 1750416566
Optometrist organization in South Pasadena, California. Organization record, active in the CMS NPPES registry since February 22, 2007.
## Identity
- **NPI:** 1750416566 (Entity type: Organization)
- **Enumerated:** February 22, 2007
- **Primary specialty:** Optometrist · taxonomy 152W00000X
- **Organization subpart:** No
- **Authorized official:** Annie Lee Kim, OPTOMETRIST
## Practice location
- **Address:** 729 MISSION ST STE 200, South Pasadena, CA 91030-3072
- **Phone:** (626) 441-5300 · **Fax:** (626) 441-2880
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Medicare revalidation due:** February 28, 2027 (Non-DME Part B, California, Clinic/Group Practice) · CMS Revalidation Due Date List, October 2026 release
- **Clinicians billing through this organization:** 8 clinicians (Optometry) reassign Medicare billing to this organization (form CMS-855R); 4 practice at this address and 6 within 10 miles · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** December 21, 2018
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Source: [NPI Profile](https://npiprofile.com/npi/1750416566) · Data from the CMS NPPES public registry.