Individual provider Active NPI

Tara Suzanne Shields, O.D.

  • Optometrist
  • Lancaster, CA
National Provider Identifier
1609056852
Registry record updated Nov 5, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
13444 Issued in CA
Practice address
43927 15TH St W
Lancaster, CA 93534-4758
Phone
(661) 948-6310
Fax
(611) 948-6880
NPI assigned
Nov 5, 2007
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 5, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 13444 CA Primary

Addresses

Primary practice location

43927 15TH St W
Lancaster, CA 93534-4758

Mailing address

43927 15TH St W
Lancaster, CA 93534-4758
Phone (661) 948-6310

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
I20080516000257 CA Practitioner - Optometry 9335218320 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Southern California College of Optometry, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Antelope Valley Optometric Center, Inc.Group PAC ID 2860437068, 3 clinicians

Practice addresses (Care Compare)

1745 W Ave K a
Lancaster, CA 93534-6502
Phone (661) 942-8437

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Antelope Valley Optometric Center, Inc. Optometrist CurrentSince May 22, 2013 Accepting new patients

Locations

1745 W Avenue K
Ste A
Lancaster, CA 93534
Phone (661) 942-8437

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": "1194220800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1194220800000",
    "number": "1609056852",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "43927 15TH ST W",
            "city": "LANCASTER",
            "state": "CA",
            "postal_code": "935344758",
            "telephone_number": "661-948-6310",
            "fax_number": "611-948-6880"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "43927 15TH ST W",
            "city": "LANCASTER",
            "state": "CA",
            "postal_code": "935344758",
            "telephone_number": "661-948-6310",
            "fax_number": "611-948-6880"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHIELDS",
        "first_name": "TARA",
        "middle_name": "SUZANNE",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-11-05",
        "last_updated": "2007-11-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "13444",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lancaster, CA

Sources for this page

Verify at the official NPI Registry.