Individual provider Active NPI

Anthony Bart Nesburn, MD

  • Ophthalmology Physician
  • Los Angeles, CA
National Provider Identifier
1588678957
Registry record updated Feb 13, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
License
G6938 Issued in CA
Practice address
8635 W 3Rd Street
#390W
Los Angeles, CA 90048-6101
Phone
(310) 652-1133
Fax
(310) 652-4353
NPI assigned
Jul 28, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 13, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ophthalmology Physician 207W00000X G6938 CA Primary

Addresses

Primary practice location

8635 W 3Rd Street
#390W
Los Angeles, CA 90048-6101

Mailing address

8635 W 3Rd Street
#390W
Los Angeles, CA 90048-6101
Phone (310) 652-1133

Other identifiers 1

IdentifierTypeStateIssuer
OOG69380MedicaidCA

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: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20080114000866 CA Practitioner - Ophthalmology 0244311496 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Ophthalmology
Education
Harvard Medical School, 1960
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
American Eye Institute a Medical CorpGroup PAC ID 7012955107, 6 clinicians

Practice addresses (Care Compare)

6330 San Vicente Blvd
Suite 408
Los Angeles, CA 90048-5462
Phone (310) 652-1133

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
6938CAMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
American Eye Institute a Medical Corp Ophthalmology CurrentSince Jan 1, 1997 Accepting new patients

Locations

6330 San Vicente Blvd
Ste 408
Los Angeles, CA 90048
Phone (310) 652-1133

8635 W 3rd St
Ste 390W
Los Angeles, CA 90048
Phone (310) 652-1133

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1154044800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1202860800000",
    "number": "1588678957",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8635 W 3RD STREET",
            "address_2": "#390W",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900486101",
            "telephone_number": "310-652-1133",
            "fax_number": "310-652-4353"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8635 W 3RD STREET",
            "address_2": "#390W",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900486101",
            "telephone_number": "310-652-1133",
            "fax_number": "310-652-4353"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NESBURN",
        "first_name": "ANTHONY",
        "middle_name": "BART",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-28",
        "last_updated": "2008-02-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "CA",
            "license": "G6938",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "OOG69380",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Los Angeles, CA

Sources for this page

Verify at the official NPI Registry.