Active NPI
Domenic Colabella, O.D.
- Optometrist
- Glendale, CA
National Provider Identifier
1477696490
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- OPT-8443T
- Practice address
- 922 E Colorado St
Glendale, CA 91205-1224 - Phone
- (818) 246-5999
- Fax
- (818) 240-5757
- NPI assigned
- Feb 15, 2007
- Last updated
- Dec 9, 2013
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | OPT-8443T | CA | Primary |
Addresses
Primary practice location
922 E Colorado St
Glendale, CA 91205-1224
Mailing address
922 E Colorado St
Glendale, CA 91205-1224
Phone (818) 246-5999
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| OPT-08443T | Other | CA | OPTOMETRY LIC NO |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| OPT-8443T | CA | MD | Optometrist |
| 8443 | CA | MD | Massage Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1171497600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1386547200000",
"number": "1477696490",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "922 E COLORADO ST",
"city": "GLENDALE",
"state": "CA",
"postal_code": "912051224",
"telephone_number": "818-246-5999",
"fax_number": "818-240-5757"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "922 E COLORADO ST",
"city": "GLENDALE",
"state": "CA",
"postal_code": "912051224",
"telephone_number": "818-246-5999",
"fax_number": "818-240-5757"
}
],
"practiceLocations": [],
"basic": {
"last_name": "COLABELLA",
"first_name": "DOMENIC",
"name_prefix": "Dr.",
"credential": "O.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-02-15",
"last_updated": "2013-12-09",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "CA",
"license": "OPT-8443T",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "OPTOMETRY LIC NO",
"identifier": "OPT-08443T",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Glendale, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 9, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.