Active NPI
Benjamin Fouladian
- Optometrist
- Redondo Beach, CA
National Provider Identifier
1124192620
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- BOL5070
- Practice address
- 403 N Pacific Coast Hwy
#108
Redondo Beach, CA 90277-2839 - Phone
- (310) 318-6665
- Fax
- (310) 318-7117
- NPI assigned
- Nov 17, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | OPT 9702 | CA | |
| Optometrist | 152W00000X | BOL5070 | CA | Primary |
Addresses
Primary practice location
403 N Pacific Coast Hwy
#108
Redondo Beach, CA 90277-2839
Mailing address
10660 Wilshire Blvd Apt 608
Los Angeles, CA 90024-7348
Phone (310) 985-2020
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 6784926 | Medicaid | CA |
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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20070726000780 | CA | Practitioner - Optometry | 8224139746 | Practice locations: Redondo Beach, CA |
Care Compare profile
Medicare Care Compare- Specialty
- Optometry
- Education
- Pacific University - College of Optometry, 1987
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
403 N Pacific Coast Hwy
Suite 108
Redondo Beach, CA 90277-2882
Phone (310) 318-6665
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| BOL5070 | CA | MD | Optometrist |
| OPT 9702 | CA | MD | Optometrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1163721600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1210896000000",
"number": "1124192620",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10660 WILSHIRE BLVD APT 608",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900247348",
"telephone_number": "310-985-2020"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "403 N PACIFIC COAST HWY",
"address_2": "#108",
"city": "REDONDO BEACH",
"state": "CA",
"postal_code": "902772839",
"telephone_number": "310-318-6665",
"fax_number": "310-318-7117"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FOULADIAN",
"first_name": "BENJAMIN",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-11-17",
"last_updated": "2008-05-16",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "CA",
"license": "OPT 9702",
"primary": false
},
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "CA",
"license": "BOL5070",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "6784926",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Redondo Beach, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 16, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.