Active NPI
Yelena Davydova, OD
- Optometrist
- El Cajon, CA
National Provider Identifier
1104981042
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 12562T
- Practice address
- 539 Parkway PLZ
El Cajon, CA 92020-2532 - Phone
- (619) 441-0138
- NPI assigned
- Dec 22, 2006
- Last updated
- Jun 24, 2008
- 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 | 12562T | CA | Primary |
Addresses
Primary practice location
539 Parkway PLZ
El Cajon, CA 92020-2532
Mailing address
8692 Lake Ashmere Dr
San Diego, CA 92119-3203
Phone (619) 957-1616
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 |
|---|---|---|---|
| 12562T | CA | MD | Optometrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Luxottica of America Inc. | Past | Accepting new patients | |
| Luxottica of America Inc | Past | 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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1166745600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1214265600000",
"number": "1104981042",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8692 LAKE ASHMERE DR",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921193203",
"telephone_number": "619-957-1616"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "539 PARKWAY PLZ",
"city": "EL CAJON",
"state": "CA",
"postal_code": "920202532",
"telephone_number": "619-441-0138"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DAVYDOVA",
"first_name": "YELENA",
"credential": "OD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-12-22",
"last_updated": "2008-06-24",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "CA",
"license": "12562T",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in El Cajon, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.