Individual provider Active NPI

Bijan Cohenmehr, OD DR OF OPTOMETRY

  • Optometrist
  • Santa Monica, CA
National Provider Identifier
1114099512
Registry record updated Feb 27, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
10047T Issued in CA
Practice address
3116 Wilshire Blvd
Santa Monica, CA 90403-2304
Phone
(310) 828-2010
Fax
(310) 828-3447
NPI assigned
Nov 14, 2006
Last updated
Feb 27, 2009By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 27, 2009

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 10047T CA Primary

Addresses

Primary practice location

3116 Wilshire Blvd
Santa Monica, CA 90403-2304

Mailing address

3116 Wilshire Blvd
Santa Monica, CA 90403-2304
Phone (310) 828-2010

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
I20120518000440 CA Practitioner - Optometry 0941463590 Practice locations: Los Angeles, CA

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
State University of New York - State College Optometry, 1986
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

12222 Wilshire Blvd
Suite 105
Los Angeles, CA 90025-1169
Phone (310) 828-2010

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
10047TCAMDOptometrist

NPI Registry JSON

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

{
    "created_epoch": "1163462400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1235692800000",
    "number": "1114099512",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3116 WILSHIRE BLVD",
            "city": "SANTA MONICA",
            "state": "CA",
            "postal_code": "904032304",
            "telephone_number": "310-828-2010",
            "fax_number": "310-828-3447"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3116 WILSHIRE BLVD",
            "city": "SANTA MONICA",
            "state": "CA",
            "postal_code": "904032304",
            "telephone_number": "310-828-2010",
            "fax_number": "310-828-3447"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COHENMEHR",
        "first_name": "BIJAN",
        "name_prefix": "Dr.",
        "credential": "OD DR OF OPTOMETRY",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-11-14",
        "last_updated": "2009-02-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "10047T",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Santa Monica, CA

Sources for this page

Verify at the official NPI Registry.