Individual provider Active NPI

Thomas Mark Hixson, OD

  • Optometrist
  • La Mesa, CA
National Provider Identifier
1528072683
Registry record updated Jan 2, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
7490T Issued in CA
Practice address
8007 La Mesa Blvd
La Mesa, CA 91941-6434
Phone
(619) 466-5665
Fax
(619) 466-5688
NPI assigned
Jul 27, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 2, 2009

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 7490T CA Primary
Corneal and Contact Management Optometrist 152WC0802X 7490T CA
Low Vision Rehabilitation Optometrist 152WL0500X 7490T CA

Addresses

Primary practice location

8007 La Mesa Blvd
La Mesa, CA 91941-6434

Mailing address

8007 La Mesa Blvd
La Mesa, CA 91941-6434
Phone (619) 466-5665

Other identifiers 1

IdentifierTypeStateIssuer
SD00749009MedicaidCA

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
I20120501000431 CA Practitioner - Optometry 5395907778

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
7490TCAMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Beyond Vision Center Optometry Inc Optometrist PastSince Dec 15, 1994 Accepting new patients

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": "1153958400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1230854400000",
    "number": "1528072683",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8007 LA MESA BLVD",
            "city": "LA MESA",
            "state": "CA",
            "postal_code": "919416434",
            "telephone_number": "619-466-5665",
            "fax_number": "619-466-5688"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8007 LA MESA BLVD",
            "city": "LA MESA",
            "state": "CA",
            "postal_code": "919416434",
            "telephone_number": "619-466-5665",
            "fax_number": "619-466-5688"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HIXSON",
        "first_name": "THOMAS",
        "middle_name": "MARK",
        "name_prefix": "Mr.",
        "credential": "OD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-27",
        "last_updated": "2009-01-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "7490T",
            "primary": true
        },
        {
            "code": "152WC0802X",
            "taxonomy_group": "",
            "desc": "Optometrist, Corneal and Contact Management",
            "state": "CA",
            "license": "7490T",
            "primary": false
        },
        {
            "code": "152WL0500X",
            "taxonomy_group": "",
            "desc": "Optometrist, Low Vision Rehabilitation",
            "state": "CA",
            "license": "7490T",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "SD00749009",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in La Mesa, CA

Sources for this page

Verify at the official NPI Registry.