Individual provider Active NPI

Yeranui Erin Gezukarayan, OD

  • Optometrist
  • Glendale, CA
National Provider Identifier
1184880247
Registry record updated May 27, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
13502 Issued in CA
Practice address
2195 Glendale Galleria
Glendale, CA 91210-2101
Phone
(818) 334-1402
NPI assigned
Jul 29, 2008
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 27, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 13502 CA Primary

Addresses

Primary practice location

2195 Glendale Galleria
Glendale, CA 91210-2101

Mailing address

10620 Wilsey Ave
Tujunga, CA 91042-1643

Other identifiers 1

IdentifierTypeStateIssuer
13502OtherCACALIFORNIA STATE BOARD OF OPTOMETRY LICENSE

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
I20090615000666 CA Practitioner - Optometry 0648320515 Practice locations: Glendale, CA

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Southern California College of Optometry, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

2195 Glendale Galleria
Glendale, CA 91210-2101
Phone (818) 550-1520

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Glendale City Optometry, Inc. Optometrist CurrentSince Mar 12, 2024 Accepting new patients
Luxottica of America Inc. Past Accepting new patients
Luxottica of America Inc Past Accepting new patients

Locations

2195 Glendale Galleria
Glendale, CA 91210
Phone (818) 334-1401

Organizations & group practices 3

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": "1217289600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1558915200000",
    "number": "1184880247",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10620 WILSEY AVE",
            "city": "TUJUNGA",
            "state": "CA",
            "postal_code": "910421643"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2195 GLENDALE GALLERIA",
            "city": "GLENDALE",
            "state": "CA",
            "postal_code": "912102101",
            "telephone_number": "818-334-1402"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GEZUKARAYAN",
        "first_name": "YERANUI",
        "middle_name": "ERIN",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-07-29",
        "last_updated": "2019-05-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "13502",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CALIFORNIA STATE BOARD OF OPTOMETRY LICENSE",
            "identifier": "13502",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Glendale, CA

Sources for this page

Verify at the official NPI Registry.