Individual provider Active NPI

Pauline F Ilsen, O.D.

  • Optometrist
  • Los Angeles, CA
National Provider Identifier
1003849712
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
8974T Issued in CA
Practice address
11301 Wilshire Blvd
West la Veterans Affairs Healthcare Ctr B 304 RM 2-111
Los Angeles, CA 90073-1003
Phone
(310) 478-3711
Fax
(310) 268-3780
NPI assigned
Jul 8, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 8974T CA Primary
Optometrist 152W00000X 1513 CO
Optometrist 152W00000X 2001T OR
Optometrist 152W00000X 2211 TN
Optometrist 152W00000X 2068 WA

Addresses

Primary practice location

11301 Wilshire Blvd
West la Veterans Affairs Healthcare Ctr B 304 RM 2-111
Los Angeles, CA 90073-1003

Mailing address

11301 Wilshire Blvd
West la Veterans Affairs Healthcare Ctr B 304 RM 2-111
Los Angeles, CA 90073-1003
Phone (310) 478-3711

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
Eligible to order & refer
  • Part B services: No
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
8974TCAMDOptometrist
2001TORMDOptometrist
2211TNMDOptometrist
2068WAMDOptometrist
8974CAMDSpeech-Language Pathologist

NPI Registry JSON

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

{
    "created_epoch": "1152316800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1003849712",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11301 WILSHIRE BLVD",
            "address_2": "WEST LA VETERANS AFFAIRS HEALTHCARE CTR B 304 RM 2-111",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900731003",
            "telephone_number": "310-478-3711",
            "fax_number": "310-268-3780"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11301 WILSHIRE BLVD",
            "address_2": "WEST LA VETERANS AFFAIRS HEALTHCARE CTR B 304 RM 2-111",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900731003",
            "telephone_number": "310-478-3711",
            "fax_number": "310-268-3780"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ILSEN",
        "first_name": "PAULINE",
        "middle_name": "F",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-08",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "8974T",
            "primary": true
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CO",
            "license": "1513",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "OR",
            "license": "2001T",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "TN",
            "license": "2211",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "WA",
            "license": "2068",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Los Angeles, CA

Sources for this page

Verify at the official NPI Registry.