Active NPI
Sylvia Rebecca Mishoulam, O.D.
- Optometrist
- Merrillville, IN
National Provider Identifier
1104113760
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 18003683A
- Practice address
- 1310 E 79TH Ave
Merrillville, IN 46410-5768 - Phone
- (219) 641-6406
- NPI assigned
- Jul 5, 2011
- Last updated
- Aug 29, 2015
- 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 | 18003683A | IN | Primary |
Addresses
Primary practice location
1310 E 79TH Ave
Merrillville, IN 46410-5768
Mailing address
1310 E 79TH Ave
Merrillville, IN 46410-5768
Phone (219) 641-6406
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 18003683A | IN | MD | Optometrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1309824000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1440806400000",
"number": "1104113760",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1310 E 79TH AVE",
"city": "MERRILLVILLE",
"state": "IN",
"postal_code": "464105768",
"telephone_number": "219-641-6406"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1310 E 79TH AVE",
"city": "MERRILLVILLE",
"state": "IN",
"postal_code": "464105768",
"telephone_number": "219-641-6406"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MISHOULAM",
"first_name": "SYLVIA",
"middle_name": "REBECCA",
"credential": "O.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-07-05",
"last_updated": "2015-08-29",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "IN",
"license": "18003683A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Merrillville, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 29, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.