George Mario Wolfus, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

4908T Issued in CA

Practice address

17149 Citronia St
Northridge, CA 91325-1931

Phone

(818) 341-1190

Fax

(818) 341-1190

NPI assigned

Oct 24, 2005

Last updated

Nov 16, 2012By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Dr. George Mario Wolfus Professional name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1130112000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1353024000000",
    "number": "1487644365",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17149 CITRONIA ST",
            "city": "NORTHRIDGE",
            "state": "CA",
            "postal_code": "913251931",
            "telephone_number": "818-341-1190",
            "fax_number": "818-341-1190"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17149 CITRONIA ST",
            "city": "NORTHRIDGE",
            "state": "CA",
            "postal_code": "913251931",
            "telephone_number": "818-341-1190",
            "fax_number": "818-341-1190"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WOLFUS",
        "first_name": "GEORGE",
        "middle_name": "MARIO",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-10-24",
        "last_updated": "2012-11-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "4908T",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "SD0049080",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "SD0049080",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "GEORGE",
            "last_name": "WOLFUS",
            "middle_name": "MARIO",
            "prefix": "DR.",
            "credential": "OD",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

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• Optometrist in Northridge, CA
• Providers in Northridge, CA by specialty
• Optometrist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 16, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.