Individual provider Active NPI

Lisa M. Wahl, O.D.

  • Optometrist
  • Los Angeles, CA
National Provider Identifier
1396170015
Registry record updated Sep 12, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
14724 Issued in CA
Practice address
2330 W Live Oak Dr
Los Angeles, CA 90068-2530
Phone
(213) 447-6495
NPI assigned
Sep 12, 2013
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 12, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 14724 CA Primary

Addresses

Primary practice location

2330 W Live Oak Dr
Los Angeles, CA 90068-2530

Mailing address

2330 W Live Oak Dr
Los Angeles, CA 90068-2530
Phone (213) 447-6495

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
I20150519001946 CA Practitioner - Optometry 8224358056 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Southern California College of Optometry, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Marshall B Ketchum UniversityGroup PAC ID 9739075177, 56 clinicians

Practice addresses (Care Compare)

3916 S Broadway
Los Angeles, CA 90037-1307
Phone (323) 234-9137

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Marshall B. Ketchum University Optometrist Current Accepting new patients
Marshall B. Ketchum University/University Eye Center at Los Angeles Optometrist CurrentSince Apr 15, 2015 Accepting new patients
Marshall B. Ketchum University CurrentSince Apr 15, 2015 Accepting new patients

Locations

3916 S Broadway
Los Angeles, CA 90037
Phone (323) 234-9137

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

  • FHIR API: https://fhir.meditouchehr.com/api/fhir/r4/

Organizations & group practices 3

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": "1378944000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1378944000000",
    "number": "1396170015",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2330 W LIVE OAK DR",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900682530",
            "telephone_number": "213-447-6495"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2330 W LIVE OAK DR",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900682530",
            "telephone_number": "213-447-6495"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAHL",
        "first_name": "LISA",
        "middle_name": "M.",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-09-12",
        "last_updated": "2013-09-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "14724",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Los Angeles, CA

Sources for this page

Verify at the official NPI Registry.