Optometric Specialties Inc

Primary specialty

OptometristTaxonomy code 152W00000X

License

COR 889 Issued in CA

Legal business name

OPTOMETRIC SPECIALTIES INC

Practice address

3750 Santa Rosalia Dr Ste 102
Los Angeles, CA 90008-3685

Phone

(323) 294-7517

NPI assigned

Dec 16, 2005

Organization subpart

No

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

Authorized official

Name

Dr. Eric E Gaylord, O.D.NPI 1255317780

Title

Owner

Phone

(323) 294-7517

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

• Optometric Specialties Inc

  • Optometrist
  • Garden Grove, CA
  • NPI 1952569634

  O20041129000759

  Same enrollment

Locations

Practitioners 2

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

• Eric E Gaylord, O.D.

  • Optometrist
  • Los Angeles, CA
  • NPI 1255317780
  Medicare reassignment Care Compare group NPD Authorized official
• Ann Inman Gaylord, O.D.

  • Optometrist
  • Garden Grove, CA
  • NPI 1851561930
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1134691200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1529107200000",
    "number": "1023094570",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3750 SANTA ROSALIA DR STE 102",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900083685",
            "telephone_number": "323-294-7517"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3750 SANTA ROSALIA DR STE 102",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900083685",
            "telephone_number": "323-294-7517"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3756 Santa Rosalia Dr",
            "address_2": "Suite 100",
            "address_purpose": "LOCATION",
            "city": "Los Angeles",
            "state": "CA",
            "postal_code": "900083606",
            "country_code": "US",
            "telephone_number": "323-294-7517",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "12902 Brookhurst St Ste A",
            "address_purpose": "LOCATION",
            "city": "Garden Grove",
            "state": "CA",
            "postal_code": "928404881",
            "country_code": "US",
            "telephone_number": "714-530-2020",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "OPTOMETRIC SPECIALTIES INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-12-16",
        "last_updated": "2018-06-16",
        "status": "A",
        "authorized_official_last_name": "GAYLORD",
        "authorized_official_first_name": "ERIC",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "323-294-7517",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "CA",
            "license": "COR 889",
            "primary": true
        },
        {
            "code": "332H00000X",
            "taxonomy_group": "",
            "desc": "Eyewear Supplier",
            "state": "CA",
            "license": "COR 889",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GSD004160",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Optimum Urgent Care
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• Opto Bar Optometric Inc
• Optometric Eye Institute PC
• Optometric Eyesite Inc
• Optometrix
• Optumcare Management, LLC
• Optumcare Management, LLC
• Optumcare Management, LLC
• Opus Physical Therapy and Performance

• Optometrist in Los Angeles, CA
• Providers in Los Angeles, CA by specialty
• Optometrist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2018; 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.