Nicole Ilanah Kohan, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

15243TLG Issued in CA

Practice address

695 W Foothill Blvd
Claremont, CA 91711-3490

Phone

(099) 625-7861

NPI assigned

Mar 19, 2015

Last updated

Oct 20, 2020By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

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

Southern California College of Optometry, 2015

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Brad a Baggarly O D IncGroup PAC ID 6901142744, 3 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Brad a Baggarly O D Inc

  dba Claremont Optometry

  • Optometrist
  • Claremont, CA
  • NPI 1790249977
  Medicare reassignment Care Compare group NPD
• Nicole Kohan, O.D., Inc.

  dba Mountain Eyes Optometric Center

  • Optometrist
  • Upland, CA
  • NPI 1609493824
  Authorized official Same address or phone
• Claremont Optometry Group

  • Optometrist
  • Claremont, CA
  • NPI 1710105846
  NPD (past)

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

{
    "created_epoch": "1426723200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1603152000000",
    "number": "1093109738",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9798 FOOTHILL BLVD STE B",
            "city": "RANCHO CUCAMONGA",
            "state": "CA",
            "postal_code": "917303692",
            "telephone_number": "714-328-4159"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "695 W FOOTHILL BLVD",
            "city": "CLAREMONT",
            "state": "CA",
            "postal_code": "917113490",
            "telephone_number": "099-625-7861"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOHAN",
        "first_name": "NICOLE",
        "middle_name": "ILANAH",
        "credential": "OD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-03-19",
        "last_updated": "2020-10-20",
        "certification_date": "2020-10-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "15243TLG",
            "primary": true
        },
        {
            "code": "152WC0802X",
            "taxonomy_group": "",
            "desc": "Optometrist, Corneal and Contact Management",
            "state": "CA",
            "license": "15243TLG",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Anna King, LCSW
• Kathleen Anne King, NP
• Kitichai Rungcharassaeng DDS, Ms, and Howard Lee, DMD, Ms, Inc
• Christine Jennifer Knapp-Phillips, FNP
• Suzanne Gaudineer Knutzen, NP
• Thomas Christopher Kono-Flores, D.D.S.
• Jasmina Koprivica, OD
• Mary Kathleen Krater, M.A., CCC-SLP
• Ava Kung, DDS
• Joshua Kusumo, D.D.S

• Optometrist in Claremont, CA
• Providers in Claremont, CA by specialty
• Optometrist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 20, 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.