Active NPI
Pauline F Ilsen, O.D.
- Optometrist
- Los Angeles, CA
National Provider Identifier
1003849712
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 8974T
- 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
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 5
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| 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
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 8974T | CA | MD | Optometrist |
| 2001T | OR | MD | Optometrist |
| 2211 | TN | MD | Optometrist |
| 2068 | WA | MD | Optometrist |
| 8974 | CA | MD | Speech-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
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.