Active NPI
Amanda Powers Havens, O.D.
- Optometrist
- Los Angeles, CA
National Provider Identifier
1083901409
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- OPT14369
- Practice address
- 200 Stein PLZ
Suite 1-340
Los Angeles, CA 90095-0001 - Phone
- (310) 825-5000
- NPI assigned
- Jul 6, 2011
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | OPT14369 | CA | Primary |
Addresses
Primary practice location
200 Stein PLZ
Suite 1-340
Los Angeles, CA 90095-0001
Mailing address
5767 W Century Blvd
Suite 400
Los Angeles, CA 90045-5631
Phone (310) 825-5000
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| OPT143690 | Medicaid | CA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| OPT14369 | CA | MD | Optometrist |
| 14369 | CA | MD | Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| South Bay Optometry, Inc. | Optometrist | Current | Accepting new patients |
| Palos Verdes Family Vision | Optometrist | Current | Accepting new patients |
Organizations & group practices 2
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.
-
- Optometrist
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- NPI 1215143615
-
- Optometrist
- Torrance, CA
- NPI 1285975458
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1309910400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1604534400000",
"number": "1083901409",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5767 W CENTURY BLVD",
"address_2": "SUITE 400",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900455631",
"telephone_number": "310-825-5000"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "200 STEIN PLZ",
"address_2": "SUITE 1-340",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900950001",
"telephone_number": "310-825-5000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HAVENS",
"first_name": "AMANDA",
"middle_name": "POWERS",
"credential": "O.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-07-06",
"last_updated": "2020-11-05",
"certification_date": "2020-11-05",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "CA",
"license": "OPT14369",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "OPT143690",
"state": "CA"
}
],
"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 Nov 5, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.