NPIMap

Organization Active NPI

Gary L Etting OD an Optometric Corp

  • Optometrist
  • Encino, CA
National Provider Identifier
1306950829
Registry record updated Dec 2, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
OPT5519 Issued in CA
Legal business name
GARY L ETTING OD AN OPTOMETRIC CORP
Practice address
6345 Balboa Blvd
BLDG 3 Suite 250
Encino, CA 91316
Phone
(818) 344-3937
Fax
(818) 344-1229
NPI assigned
Aug 19, 2006
Last updated
Dec 2, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 2, 2014

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

Authorized official

Name
Dr. Gary L Etting, ODNPI 1912969619
Title
Owner
Phone
(818) 344-3937

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 152W00000X OPT 5519 T CA
OptometristGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 152W00000X OPT5519 CA Primary
Vision Therapy OptometristGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 152WV0400X OPT 5519 T CA

Addresses

Primary practice location

6345 Balboa Blvd
BLDG 3 Suite 250
Encino, CA 91316

Mailing address

6345 Balboa Blvd
BLDG 3 Suite 250
Encino, CA 91316
Phone (818) 344-3937

Other identifiers 1

IdentifierTypeStateIssuer
WOP5519AOtherCAOTHER MEDICARE PTAN

National Provider Directory

National Provider Directory

Locations

6345 Balboa Blvd
Bldg 3
Encino, CA 91316

6345 Balboa Blvd
Ste 250
Encino, CA 91316
Phone (818) 344-3937

2001 S Barrington Ave
Ste 318
Los Angeles, CA 90025
Phone (310) 477-4009

Practitioners & affiliated clinicians

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1155945600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1417478400000",
    "number": "1306950829",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6345 BALBOA BLVD",
            "address_2": "BLDG 3 SUITE 250",
            "city": "ENCINO",
            "state": "CA",
            "postal_code": "91316",
            "telephone_number": "818-344-3937",
            "fax_number": "818-344-1229"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6345 BALBOA BLVD",
            "address_2": "BLDG 3 SUITE 250",
            "city": "ENCINO",
            "state": "CA",
            "postal_code": "91316",
            "telephone_number": "818-344-3937",
            "fax_number": "818-344-1229"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GARY L ETTING OD AN OPTOMETRIC CORP",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-19",
        "last_updated": "2014-12-02",
        "status": "A",
        "authorized_official_last_name": "ETTING",
        "authorized_official_first_name": "GARY",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "818-344-3937",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": "CA",
            "license": "OPT 5519 T",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": "CA",
            "license": "OPT5519",
            "primary": true
        },
        {
            "code": "152WV0400X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Optometrist, Vision Therapy",
            "state": "CA",
            "license": "OPT 5519 T",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OTHER MEDICARE PTAN",
            "identifier": "WOP5519A",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Encino, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 2, 2014; 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.