Los Angeles Institute for Ophthalmic Surgery

Primary specialty

Ophthalmology PhysicianTaxonomy code 207W00000X

License

G39377 Issued in CA

Legal business name

LOS ANGELES INSTITUTE FOR OPHTHALMIC SURGERY

Practice address

5363 Balboa Blvd
Suite 545
Encino, CA 91316-2805

Phone

(818) 906-2929

Fax

(818) 906-0567

NPI assigned

Sep 20, 2006

Last updated

Jan 27, 2010By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

David Michael Colvard, M.D.

Title

President

Phone

(818) 906-2929

Specialties & licenses 1

Addresses

Other identifiers 1

Networks

• BSC 65 PLUS INDIVIDUAL MAPDPlans: Blue Shield 65 Plus (HMO) (H0504-015-000, H0504); Blue Shield 65 Plus (HMO) (H0504-039-000, H0504); Blue Shield 65 Plus Plan 2 (HMO) (H0504-021-000, H0504); Blue Shield Inspire (HMO) (H0504-041-000, H0504); Blue Shield 65 Plus (HMO) (H0504-038-000, H0504); Blue Shield Inspire (HMO) (H0504-047-000, H0504); Blue Shield 65 Plus (HMO) (H0504-026-000, H0504); Blue Shield Advantage (HMO) (H0504-050-000, H0504); Blue Shield AdvantageOptimum Plan (HMO) (H5928-004-000, H5928); Blue Shield Inspire (HMO) (H0504-043-000, H0504)…

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

{
    "created_epoch": "1158710400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1264550400000",
    "number": "1275631434",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5363 BALBOA BLVD",
            "address_2": "SUITE 545",
            "city": "ENCINO",
            "state": "CA",
            "postal_code": "913162805",
            "telephone_number": "818-906-2929",
            "fax_number": "818-906-0567"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5363 BALBOA BLVD",
            "address_2": "SUITE 545",
            "city": "ENCINO",
            "state": "CA",
            "postal_code": "913162805",
            "telephone_number": "818-906-2929",
            "fax_number": "818-906-0567"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LOS ANGELES INSTITUTE FOR OPHTHALMIC SURGERY",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-20",
        "last_updated": "2010-01-27",
        "status": "A",
        "authorized_official_last_name": "COLVARD",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "MICHAEL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "818-906-2929",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Ophthalmology",
            "state": "CA",
            "license": "G39377",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0071330",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Ophthalmology Physician in Encino, CA
• Providers in Encino, CA by specialty
• Ophthalmology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 27, 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.