NPIMap

Organization Active NPI

Larry J Gottlieb Inc a Professional Corporation

Doing business as Dr Gottlieb Optometry

  • Optometrist
  • Lakewood, CA
National Provider Identifier
1013176130
Registry record updated Jun 24, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
6451T Issued in CA
Legal business name
LARRY J GOTTLIEB INC A PROFESSIONAL CORPORATION
Doing business as
Dr Gottlieb Optometry
Practice address
6418 E del Amo Blvd
Lakewood, CA 90713
Phone
(562) 420-2055
Fax
(562) 420-1784
NPI assigned
Jun 4, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 24, 2015

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

Authorized official

Name
Dr. Larry J Gottlieb, ODNPI 1609900653
Title
President
Phone
(562) 420-2055

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X 6451T CA Primary

Addresses

Primary practice location

6418 E del Amo Blvd
Lakewood, CA 90713

Mailing address

6418 E del Amo Blvd
Lakewood, CA 90713
Phone (562) 420-2055

Other names 1

  • Dr Gottlieb Optometry Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040712001609 CA Part B Supplier - Clinic/Group Practice 8527046887 Receives reassigned benefits from 2 practitioners
Practice locations: Lakewood, CA

National Provider Directory

National Provider Directory
Tax ID family
Dr Gottlieb Optometry2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

2800 N Main St
Santa Ana, CA 92705
Phone (714) 543-3333

Practitioners & affiliated clinicians

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1212537600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1435104000000",
    "number": "1013176130",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6418 E DEL AMO BLVD",
            "city": "LAKEWOOD",
            "state": "CA",
            "postal_code": "90713",
            "telephone_number": "562-420-2055",
            "fax_number": "562-420-1784"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6418 E DEL AMO BLVD",
            "city": "LAKEWOOD",
            "state": "CA",
            "postal_code": "90713",
            "telephone_number": "562-420-2055",
            "fax_number": "562-420-1784"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LARRY J GOTTLIEB INC A PROFESSIONAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-06-04",
        "last_updated": "2015-06-24",
        "status": "A",
        "authorized_official_last_name": "GOTTLIEB",
        "authorized_official_first_name": "LARRY",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "562-420-2055",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "CA",
            "license": "6451T",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Dr Gottlieb Optometry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lakewood, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.