Individual provider Active NPI

Patricia Adriana Atie, O.D., F.C.O.V.D.

  • Optometrist
  • Santa Ana, CA
National Provider Identifier
1255435517
Registry record updated Mar 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
8962T Issued in CA
Practice address
2414 S Fairview
#103
Santa Ana, CA 92704
Phone
(714) 557-9492
Fax
(714) 557-2548
NPI assigned
Sep 8, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 7, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 8962T CA Primary

Addresses

Primary practice location

2414 S Fairview
#103
Santa Ana, CA 92704

Mailing address

2414 S Fairview
#103
Santa Ana, CA 92704
Phone (714) 557-9492

Other identifiers 1

IdentifierTypeStateIssuer
SD0089620MedicaidCA

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
I20090917000444 CA Practitioner - Optometry 5698821585 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
8962TCAMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Paje Optometric a Professional Corporation Optometrist CurrentSince Nov 16, 2009 Accepting new patients
Hilton Manor, LLC Past Accepting new patients

Locations

2615 Grand Ave
Long Beach, CA 90815
Phone (562) 283-0502

1618 Laurel Ave
Redlands, CA 92373
Phone (909) 792-6050

8171 Magnolia Ave
Riverside, CA 92504
Phone (951) 657-3842

2414 S Fairview St
Ste 103
Santa Ana, CA 92704
Phone (714) 557-9442

240 Hospital Cir
Westminster, CA 92683
Phone (714) 892-6686

Organizations & group practices 2

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": "1157673600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1255435517",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2414 S FAIRVIEW",
            "address_2": "#103",
            "city": "SANTA ANA",
            "state": "CA",
            "postal_code": "92704",
            "telephone_number": "714-557-9492",
            "fax_number": "714-557-2548"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2414 S FAIRVIEW",
            "address_2": "#103",
            "city": "SANTA ANA",
            "state": "CA",
            "postal_code": "92704",
            "telephone_number": "714-557-9492",
            "fax_number": "714-557-2548"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ATIE",
        "first_name": "PATRICIA",
        "middle_name": "ADRIANA",
        "name_prefix": "Dr.",
        "credential": "O.D., F.C.O.V.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-08",
        "last_updated": "2023-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "8962T",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "SD0089620",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Santa Ana, CA

Sources for this page

Verify at the official NPI Registry.