Bonnie Lauren Samuelson, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

34540 Issued in CA

Practice address

21161 Newport Coast Dr
Newport Beach, CA 92657-1123

Phone

(949) 640-4733

Fax

(949) 287-0186

NPI assigned

Jun 23, 2020

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Optometry

Education

Stanford University School of Medicine, 2015

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

David B Rosenblum O D IncGroup PAC ID 1153550264, 5 clinicians

Nusite OptometryGroup PAC ID 8123382884, 5 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• David B Rosenblum O D Inc

  dba Eyesite Optometry

  • Optometrist
  • Cerritos, CA
  • NPI 1720239288
  Medicare reassignment Care Compare group NPD
• Nusite Optometry

  dba Orange County Eyecare Optometry

  • Optometrist
  • Placentia, CA
  • NPI 1750886073
  Medicare reassignment Care Compare group
• Orange County Eyecare Optometry Inc .

  • Optometrist
  • Placentia, CA
  • NPI 1346312014
  NPD
• Nusite Optometry

  dba Eyesite Optometry

  • Optometrist
  • Newport Beach, CA
  • NPI 1396636932
  NPD (past)

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

{
    "created_epoch": "1592870400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1592870400000",
    "number": "1073139291",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9862 KINGS CANYON DR",
            "city": "HUNTINGTON BEACH",
            "state": "CA",
            "postal_code": "926464829",
            "telephone_number": "714-745-9312"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21161 NEWPORT COAST DR",
            "city": "NEWPORT BEACH",
            "state": "CA",
            "postal_code": "926571123",
            "telephone_number": "949-640-4733",
            "fax_number": "949-287-0186"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SAMUELSON",
        "first_name": "BONNIE",
        "middle_name": "LAUREN",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-06-23",
        "last_updated": "2020-06-23",
        "certification_date": "2020-06-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "34540",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Bryan Samson, PT, DPT
• Natalie Samson, CGC
• Christine Samuel, NP
• Ryan Blake Samuelian, DC
• Carolyn Ann Samuels, LMT
• Sanaz Khorrami MD, Inc.
• Laura Graciela Sanchez Solis
• Estrella Sanchez-Kasai
• Arianna Lola Sanchez
• Edith Araceli Sanchez

• Optometrist in Newport Beach, CA
• Providers in Newport Beach, CA by specialty
• Optometrist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 23, 2020; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.