Individual provider Active NPI

Ifeoma Lawretta Ezeani, OD

  • Optometrist
  • Carson, CA
National Provider Identifier
1407816911
Registry record updated Jul 13, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
12478T Issued in CA
Practice address
20763 Avalon Blvd
Carson, CA 90746
Phone
(310) 464-8300
Fax
(310) 464-8304
NPI assigned
Mar 27, 2006
Last updated
Jul 13, 2026By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 13, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 12478T CA Primary

Addresses

Primary practice location

20763 Avalon Blvd
Carson, CA 90746

Mailing address

3925 Via Cardelina
Palos Verdes Estate, CA 90274
Phone (310) 378-0291

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
I20040505000873 CA Practitioner - Optometry 4981692159 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
New England College of Optometry, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
County of Los AngelesGroup PAC ID 1850296534, 395 clinicians

Practice addresses (Care Compare)

5850 S Main St
Los Angeles, CA 90003-1215
Phone (323) 897-6000

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
12478TCAMDOptometrist
12478CAMDHand Occupational Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
County of Los Angeles CurrentSince Jul 17, 2017 Accepting new patients
County of Los Angeles CurrentSince Jul 17, 2017 Accepting new patients
County of Los Angeles Current Accepting new patients
Memorial Medical Group Inc Past Accepting new patients
Healthcare Partners Affiliates Medical Group Past Accepting new patients
Ezeani DDS Dental Corp Past Accepting new patients

Locations

1000 S Fremont Ave
Unit 9
Alhambra, CA 91803

5850 S Main St
Los Angeles, CA 90003
Phone (323) 846-4312

Organizations & group practices 6

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1143417600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783900800000",
    "number": "1407816911",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3925 VIA CARDELINA",
            "city": "PALOS VERDES ESTATE",
            "state": "CA",
            "postal_code": "90274",
            "telephone_number": "310-378-0291",
            "fax_number": "310-469-8304"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20763 AVALON BLVD",
            "city": "CARSON",
            "state": "CA",
            "postal_code": "90746",
            "telephone_number": "310-464-8300",
            "fax_number": "310-464-8304"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EZEANI",
        "first_name": "IFEOMA",
        "middle_name": "LAWRETTA",
        "name_prefix": "Mrs.",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-03-27",
        "last_updated": "2026-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "12478T",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Carson, CA

Sources for this page

Verify at the official NPI Registry.