Active NPI
James Licata, LDO
- Optician
- Mesa, AZ
National Provider Identifier
1295029072
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optician
- License
- 748
- Practice address
- 2048 E Baseline Rd # C-6
Mesa, AZ 85204-6969 - Phone
- (480) 632-5075
- Fax
- (480) 507-0836
- NPI assigned
- Jun 8, 2011
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optician | 156FX1800X | 748 | AZ | Primary |
Addresses
Primary practice location
2048 E Baseline Rd # C-6
Mesa, AZ 85204-6969
Mailing address
2048 E Baseline Rd # C-6
Mesa, AZ 85204-6969
Phone (480) 632-5075
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 |
|---|---|---|---|
| 748 | AZ | MD | Optician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Licata Optical LLC | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Eyewear Supplier
- Mesa, AZ
- NPI 1851675003
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1307491200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1307491200000",
"number": "1295029072",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2048 E BASELINE RD # C-6",
"city": "MESA",
"state": "AZ",
"postal_code": "852046969",
"telephone_number": "480-632-5075",
"fax_number": "480-507-0836"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2048 E BASELINE RD # C-6",
"city": "MESA",
"state": "AZ",
"postal_code": "852046969",
"telephone_number": "480-632-5075",
"fax_number": "480-507-0836"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LICATA",
"first_name": "JAMES",
"credential": "LDO",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2011-06-08",
"last_updated": "2011-06-08",
"status": "A"
},
"taxonomies": [
{
"code": "156FX1800X",
"taxonomy_group": "",
"desc": "Technician/Technologist, Optician",
"state": "AZ",
"license": "748",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mesa, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 8, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.