Active NPI
Basil Mubarkeh
- Optometrist
- Lancaster, CA
National Provider Identifier
1003656802
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 35675
- Practice address
- 45104 10TH St W
Lancaster, CA 93534-2310 - Phone
- (661) 941-9543
- NPI assigned
- May 29, 2024
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 35675 | CA | Primary |
Addresses
Primary practice location
45104 10TH St W
Lancaster, CA 93534-2310
Mailing address
18201 Shannon Ridge PL
Canyon Country, CA 91387-8135
Phone (661) 839-3915
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 35675 | CA | MD | Orthodontics and Dentofacial Orthopedic Dentist |
Interoperability endpoints
- basil.mubarkehod.p1@direct.jwch.nextgenshare.com
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1716940800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1716940800000",
"number": "1003656802",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "18201 SHANNON RIDGE PL",
"city": "CANYON COUNTRY",
"state": "CA",
"postal_code": "913878135",
"telephone_number": "661-839-3915"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "45104 10TH ST W",
"city": "LANCASTER",
"state": "CA",
"postal_code": "935342310",
"telephone_number": "661-941-9543"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MUBARKEH",
"first_name": "BASIL",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2024-05-29",
"last_updated": "2024-05-29",
"certification_date": "2024-05-29",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "CA",
"license": "35675",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lancaster, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 29, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.