Individual provider Active NPI

Alysa E. Watanabe, O.D.

  • Optometrist
  • Monrovia, CA
National Provider Identifier
1467617175
Registry record updated Mar 23, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
13555 Issued in CA
Practice address
525 S Myrtle Ave
Suite 107
Monrovia, CA 91016-5103
Phone
(626) 359-3937
NPI assigned
Jul 22, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 23, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 13555 CA Primary

Addresses

Primary practice location

525 S Myrtle Ave
Suite 107
Monrovia, CA 91016-5103

Mailing address

525 S Myrtle Ave
Suite 107
Monrovia, CA 91016-5103
Phone (626) 359-3937

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
I20081209000613 CA Practitioner - Optometry 9537220512 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Southern California College of Optometry, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Teruo Watanabe OD IncGroup PAC ID 2365521697, 2 clinicians

Practice addresses (Care Compare)

525 S Myrtle Ave
Suite 107
Monrovia, CA 91016-6139
Phone (626) 359-3937

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
13555CAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Teruo Watanabe, O.D., Inc. Optometrist CurrentSince Nov 15, 2018 Accepting new patients
Teruo Watanabe, O.D., Inc. Optometrist PastSince Nov 15, 2018 Accepting new patients

Locations

525 S Myrtle Ave
Ste 107
Monrovia, CA 91016
Phone (626) 359-3937

Organizations & group practices 2

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": "1216684800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1332460800000",
    "number": "1467617175",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "525 S MYRTLE AVE",
            "address_2": "SUITE 107",
            "city": "MONROVIA",
            "state": "CA",
            "postal_code": "910165103",
            "telephone_number": "626-359-3937"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "525 S MYRTLE AVE",
            "address_2": "SUITE 107",
            "city": "MONROVIA",
            "state": "CA",
            "postal_code": "910165103",
            "telephone_number": "626-359-3937"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WATANABE",
        "first_name": "ALYSA",
        "middle_name": "E.",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-07-22",
        "last_updated": "2012-03-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "13555",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Monrovia, CA

Sources for this page

Verify at the official NPI Registry.