Individual provider Active NPI

David Mark Kasanoff, O.D.

  • Optometrist
  • La Mesa, CA
National Provider Identifier
1114093622
Registry record updated Jun 6, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
CA8755T Issued in CA
Practice address
7339 El Cajon Blvd Ste G
La Mesa, CA 91942-7435
Phone
(619) 465-7900
Fax
(619) 465-1642
NPI assigned
Nov 27, 2006
Last updated
Jun 6, 2010By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 6, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X CA8755T CA Primary

Addresses

Primary practice location

7339 El Cajon Blvd Ste G
La Mesa, CA 91942-7435

Mailing address

7339 El Cajon Blvd
G
La Mesa, CA 91942-7435
Phone (619) 465-7900

Other identifiers 1

IdentifierTypeStateIssuer
SD0087550MedicaidCA

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20100525000243 CA Practitioner - Optometry 2264561521 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
University of California - School of Optometry, 1987
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

7339 El Cajon Blvd
Suite G
La Mesa, CA 91942-7435
Phone (619) 465-7900

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
CA8755TCAMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Marvin R Kasanoff OD a Professional Corporation Optometrist CurrentSince Jun 20, 2009 Accepting new patients

Locations

7339 El Cajon Blvd
Ste G
La Mesa, CA 91942
Phone (619) 465-7900

Organizations & group practices 1

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": "1164585600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1275782400000",
    "number": "1114093622",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7339 EL CAJON BLVD",
            "address_2": "G",
            "city": "LA MESA",
            "state": "CA",
            "postal_code": "919427435",
            "telephone_number": "619-465-7900",
            "fax_number": "619-839-3840"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7339 EL CAJON BLVD STE G",
            "city": "LA MESA",
            "state": "CA",
            "postal_code": "919427435",
            "telephone_number": "619-465-7900",
            "fax_number": "619-465-1642"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KASANOFF",
        "first_name": "DAVID",
        "middle_name": "MARK",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-27",
        "last_updated": "2010-06-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "CA8755T",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "SD0087550",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in La Mesa, CA

Sources for this page

Verify at the official NPI Registry.