NPIMap

Organization Active NPI

Ellen Shuham OD Inc

  • Optometrist
  • Northridge, CA
National Provider Identifier
1174648943
Registry record updated Jan 21, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
OPT6899TPA Issued in CA
Legal business name
ELLEN SHUHAM OD INC
Practice address
18661 Devonshire St
Northridge, CA 91324
Phone
(818) 368-1234
Fax
(818) 363-3161
NPI assigned
Mar 20, 2007
Last updated
Jan 21, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 21, 2010

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

Authorized official

Name
Ellen Shuham, ODNPI 1629127519
Title
Dr
Phone
(818) 368-1234

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X OPT6899TPA CA Primary

Addresses

Primary practice location

18661 Devonshire St
Northridge, CA 91324

Mailing address

18661 Devonshire St
Northridge, CA 91324
Phone (818) 368-1234

Other identifiers 1

IdentifierTypeStateIssuer
GSD000050MedicaidCA

National Provider Directory

National Provider Directory

Locations

11057 Balboa Blvd
Granada Hills, CA 91344
Phone (818) 843-2214

18661 Devonshire St
Northridge, CA 91324
Phone (818) 368-1234

8447 Laurel Canyon Blvd
Sun Valley, CA 91352
Phone (818) 504-2020

Practitioners & affiliated clinicians

Practitioners 12

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1174348800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1264032000000",
    "number": "1174648943",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18661 DEVONSHIRE ST",
            "city": "NORTHRIDGE",
            "state": "CA",
            "postal_code": "91324",
            "telephone_number": "818-368-1234",
            "fax_number": "818-363-3161"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18661 DEVONSHIRE ST",
            "city": "NORTHRIDGE",
            "state": "CA",
            "postal_code": "91324",
            "telephone_number": "818-368-1234",
            "fax_number": "818-363-3161"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELLEN SHUHAM OD INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-20",
        "last_updated": "2010-01-21",
        "status": "A",
        "authorized_official_last_name": "SHUHAM",
        "authorized_official_first_name": "ELLEN",
        "authorized_official_title_or_position": "DR",
        "authorized_official_telephone_number": "818-368-1234",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "CA",
            "license": "OPT6899TPA",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GSD000050",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Northridge, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 21, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.