Individual provider Active NPI

Joseph Gergis Botrus, OD

  • Optometrist
  • Pomona, CA
National Provider Identifier
1174366090
Registry record updated Jun 18, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
OPT35741-TLG Issued in CA
Practice address
309 E 2ND St
Pomona, CA 91766-1854
Phone
(909) 623-6116
NPI assigned
Jun 18, 2024
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 18, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Vision Therapy Optometrist 152WV0400X OPT35741-TLG CA
Optometrist 152W00000X OPT35741-TLG CA Primary

Addresses

Primary practice location

309 E 2ND St
Pomona, CA 91766-1854

Mailing address

471 Mandeville Dr
Walnut, CA 91789-4719
Phone (626) 466-7086

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
I20241008003508 CA Practitioner - Optometry 9537690011 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Total Vision PCGroup PAC ID 9234472242, 115 clinicians

Practice addresses (Care Compare)

4515 Central Ave
Suite 101
Riverside, CA 92506-2374
Phone (951) 784-2420

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
OPT35741-TLGCAMDVision Therapy Optometrist
35741CAMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
Western University of Health Sciences Optometrist CurrentSince Jul 28, 2024 Accepting new patients
Western University of Health Sciences Current Accepting new patients
Western University of Health Sciences CurrentSince Jul 28, 2024 Accepting new patients
Total Vision PC Optometrist CurrentSince Feb 21, 2025 Accepting new patients

Locations

27271 Las Ramblas
Ste 210
Mission Viejo, CA 92691

795 E 2nd St
Ste 5
Pomona, CA 91766
Phone (909) 706-3877

795 E 2nd St
Ste 2
Pomona, CA 91766
Phone (909) 469-8673

309 E 2nd St
Pomona, CA 91766
Phone (909) 469-5589

4515 Central Ave
Ste 101
Riverside, CA 92506
Phone (909) 784-2420

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1718668800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1718668800000",
    "number": "1174366090",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "471 MANDEVILLE DR",
            "city": "WALNUT",
            "state": "CA",
            "postal_code": "917894719",
            "telephone_number": "626-466-7086"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "309 E 2ND ST",
            "city": "POMONA",
            "state": "CA",
            "postal_code": "917661854",
            "telephone_number": "909-623-6116"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOTRUS",
        "first_name": "JOSEPH",
        "middle_name": "GERGIS",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-06-18",
        "last_updated": "2024-06-18",
        "certification_date": "2024-06-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152WV0400X",
            "taxonomy_group": "",
            "desc": "Optometrist, Vision Therapy",
            "state": "CA",
            "license": "OPT35741-TLG",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "OPT35741-TLG",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pomona, CA

Sources for this page

Verify at the official NPI Registry.