Individual provider Active NPI

Michael C Morris, O.D.

  • Optometrist
  • West Covina, CA
National Provider Identifier
1528178191
Registry record updated Dec 14, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
5913T Issued in CA
Practice address
1000 Lakes Dr
Ste 180
West Covina, CA 91790-2927
Phone
(626) 919-4821
Fax
(626) 966-2281
NPI assigned
Aug 30, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 14, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 5913T CA Primary

Addresses

Primary practice location

1000 Lakes Dr
Ste 180
West Covina, CA 91790-2927

Mailing address

1000 Lakes Dr
Ste 180
West Covina, CA 91790-2927
Phone (626) 919-4821

Other identifiers 1

IdentifierTypeStateIssuer
SD00059130MedicaidCA

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
I20120216000327 CA Practitioner - Optometry 2961660204 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Southern California College of Optometry, 1975
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Michael Morris OD a Professional CorporationGroup PAC ID 9739135088, 2 clinicians

Practice addresses (Care Compare)

631 N Azusa Ave
Azusa, CA 91702-2910
Phone (626) 919-4821

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
5913TCAMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Michael Morris OD a Professional Corporation Optometrist CurrentSince Jan 1, 1996 Accepting new patients

Locations

631 N Azusa Ave
Azusa, CA 91702
Phone (626) 919-4821

1000 Lakes Dr
Ste 180
West Covina, CA 91790
Phone (626) 919-4821

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": "1156896000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1323820800000",
    "number": "1528178191",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1000 LAKES DR",
            "address_2": "STE 180",
            "city": "WEST COVINA",
            "state": "CA",
            "postal_code": "917902927",
            "telephone_number": "626-919-4821",
            "fax_number": "626-966-2281"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 LAKES DR",
            "address_2": "STE 180",
            "city": "WEST COVINA",
            "state": "CA",
            "postal_code": "917902927",
            "telephone_number": "626-919-4821",
            "fax_number": "626-966-2281"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MORRIS",
        "first_name": "MICHAEL",
        "middle_name": "C",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-30",
        "last_updated": "2011-12-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "5913T",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "SD00059130",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in West Covina, CA

Sources for this page

Verify at the official NPI Registry.