Active NPI
Jaclyn Rebecca Engelman, O.D.
- Optometrist
- Valley Village, CA
National Provider Identifier
1225362874
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 13862
- Practice address
- 5929 Whitsett Ave Apt 105
Valley Village, CA 91607-1183 - Phone
- (818) 300-5439
- NPI assigned
- Sep 30, 2009
- Last updated
- Jan 12, 2016
- Sex
- Female
- Sole proprietor
- No
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 | TUV007461-1 | NY | |
| Optometrist | 152W00000X | 13862 | CA | Primary |
Addresses
Primary practice location
5929 Whitsett Ave Apt 105
Valley Village, CA 91607-1183
Mailing address
5929 Whitsett Ave Apt 105
Valley Village, CA 91607-1183
Phone (818) 300-5439
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| TUV007461-1 | NY | MD | Optometrist |
| 13862 | CA | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1254268800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1452556800000",
"number": "1225362874",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5929 WHITSETT AVE APT 105",
"city": "VALLEY VILLAGE",
"state": "CA",
"postal_code": "916071183",
"telephone_number": "818-300-5439"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5929 WHITSETT AVE APT 105",
"city": "VALLEY VILLAGE",
"state": "CA",
"postal_code": "916071183",
"telephone_number": "818-300-5439"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ENGELMAN",
"first_name": "JACLYN",
"middle_name": "REBECCA",
"name_prefix": "Dr.",
"credential": "O.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2009-09-30",
"last_updated": "2016-01-12",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "NY",
"license": "TUV007461-1",
"primary": false
},
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "CA",
"license": "13862",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Valley Village, CA
- Eb Marriage and Family Therapy Professional Corporation
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- Jackson Elrod
- Nicole Emrani
- Ephram Dental Corp (Laurel Canyon Dental, Darien Ephram DDS)
- Equilogic Systems, Inc. (Innervisions Medical)
- Equitable Connections to Housing Opportunities (Echo)
- ER Hospice Care Inc
- Veronica Erzeroumian, M.A.
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 12, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.