Individual provider Active NPI

Anita Kerendian-Hakimi, O.D.

  • Optometrist
  • Los Angeles, CA
National Provider Identifier
1407906050
Registry record updated Jul 7, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
CA10532T Issued in CA
Practice address
5366 W Pico Blvd
Los Angeles, CA 90019-4036
Phone
(323) 454-8454
NPI assigned
Jan 12, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 7, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X CA10532T CA Primary

Addresses

Primary practice location

5366 W Pico Blvd
Los Angeles, CA 90019-4036

Mailing address

5366 W Pico Blvd
Los Angeles, CA 90019-4036
Phone (323) 454-8454

Other identifiers 1

IdentifierTypeStateIssuer
3690739MedicaidCA

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
I20041122000485 CA Practitioner - Optometry 8022073873 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Southern College of Optometry, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

5366 W Pico Blvd
Los Angeles, CA 90019-4036
Phone (323) 454-8454

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
CA10532TCAMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
All Eyes Optometry Inc Optometrist CurrentSince Nov 27, 2010 Accepting new patients

Locations

4972 W Pico Blvd
Ste 106B
Los Angeles, CA 90019
Phone (323) 454-8454

5366 W Pico Blvd
Los Angeles, CA 90019
Phone (323) 454-8454

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.

NPI Registry JSON

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

{
    "created_epoch": "1168560000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1594080000000",
    "number": "1407906050",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5366 W PICO BLVD",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900194036",
            "telephone_number": "323-454-8454"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5366 W PICO BLVD",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900194036",
            "telephone_number": "323-454-8454"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KERENDIAN-HAKIMI",
        "first_name": "ANITA",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-12",
        "last_updated": "2020-07-07",
        "certification_date": "2020-07-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "CA10532T",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3690739",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Los Angeles, CA

Sources for this page

Verify at the official NPI Registry.