Active NPI
Phillip Levy, O.D.
- Optometrist
- La Mesa, CA
National Provider Identifier
1528189115
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 04884T
- Practice address
- 5020 Baltimore Dr Ste B
La Mesa, CA 91941-3692 - Phone
- (619) 464-8303
- NPI assigned
- Apr 2, 2007
- 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 | 04884T | CA | Primary |
Addresses
Primary practice location
5020 Baltimore Dr Ste B
La Mesa, CA 91941-3692
Mailing address
5020 Baltimore Dr Ste B
La Mesa, CA 91942-0692
Phone (619) 464-8303
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| SD0048840 | Medicaid | CA |
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 |
|---|---|---|---|
| 04884T | CA | MD | Optometrist |
| 4884 | CA | MD | Occupational Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Tina Bui OD Inc | Optometrist | Past | 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": "1175472000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1357776000000",
"number": "1528189115",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5020 BALTIMORE DR STE B",
"city": "LA MESA",
"state": "CA",
"postal_code": "919420692",
"telephone_number": "619-464-8303"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5020 BALTIMORE DR STE B",
"city": "LA MESA",
"state": "CA",
"postal_code": "919413692",
"telephone_number": "619-464-8303"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LEVY",
"first_name": "PHILLIP",
"name_prefix": "Dr.",
"credential": "O.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-04-02",
"last_updated": "2013-01-10",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "CA",
"license": "04884T",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "SD0048840",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in La Mesa, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 10, 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.