Blair M Ball, OD
Individual provider Active NPI Optometrist · Beaumont, CA
NPI 1104972140 · NPPES record last updated Jun 11, 2010
Key facts
- NPI
- 1104972140
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Optometrist 152W00000X
- License
- SD0084220 TPL (CA)
- Practice address
- 1659 E 6TH St
Suite a
Beaumont, CA 92223-2509 - Phone
- (951) 845-0272
- Fax
- (951) 845-0143
- NPI assigned
- Jan 25, 2007
- Sex
- Male
- Sole proprietor
- Yes
Medicare Care Compare profile
- Specialty
- Optometry
- Education
- Southern California College of Optometry, 1986
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
1659 E 6TH St a
Beaumont, CA 92223-5765
Phone (951) 845-0272
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20100918000081 | CA | Practitioner - Optometry | 0547385247 |
Receives reassigned benefits from 1 practitioner Practice locations: Beaumont, CA |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| SD0084220 TPL | CA | MD | Optometrist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | SD0084220 TPL | CA | Yes |
Addresses
Primary practice location
1659 E 6TH St
Suite a
Beaumont, CA 92223-2509
Mailing address
1659 E 6TH St
Suite a
Beaumont, CA 92223-2509
Phone (951) 845-0272
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| SD0084220 | Medicaid | CA |
Other providers in Beaumont, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 11, 2010. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.