Individual provider Active NPI

Elliott J Caine, O.D

  • Optometrist
  • Los Angeles, CA
National Provider Identifier
1558355040
Registry record updated May 12, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
OPT6005T Issued in CA
Practice address
5016 York Blvd
Los Angeles, CA 90042-1714
Phone
(626) 403-9810
Fax
(626) 403-4597
NPI assigned
Sep 12, 2005
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 12, 2009

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X OPT6005T CA Primary

Addresses

Primary practice location

5016 York Blvd
Los Angeles, CA 90042-1714

Mailing address

5016 York Blvd
Los Angeles, CA 90042-1714
Phone (626) 403-9810

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
I20121116000200 CA Practitioner - Optometry 4183823040 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
OPT6005TCAMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Dr. Elliott Caine Optometry, Inc Optometrist CurrentSince Jul 6, 2009 Accepting new patients

Locations

5016 York Blvd
Los Angeles, CA 90042
Phone (323) 258-2242

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": "1126483200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1242086400000",
    "number": "1558355040",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5016 YORK BLVD",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900421714",
            "telephone_number": "626-403-9810",
            "fax_number": "626-403-4597"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5016 YORK BLVD",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900421714",
            "telephone_number": "626-403-9810",
            "fax_number": "626-403-4597"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CAINE",
        "first_name": "ELLIOTT",
        "middle_name": "J",
        "name_prefix": "Dr.",
        "credential": "O.D",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-09-12",
        "last_updated": "2009-05-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "OPT6005T",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Los Angeles, CA

Sources for this page

Verify at the official NPI Registry.