Michael David Allen, O.D.
Individual provider Active NPI Optometrist · Barstow, CA
NPI 1629003447 · NPPES record last updated Dec 1, 2021
Key facts
- NPI
- 1629003447
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Optometrist 152W00000X
- License
- 11855T (CA)
- Practice address
- 1356 E Main St Ste a
Barstow, CA 92311-3241 - Phone
- (760) 256-8014
- Fax
- (760) 256-8568
- NPI assigned
- Jul 11, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 7
Medicare Care Compare profile
- Specialty
- Optometry
- Education
- Southern College of Optometry, 2002
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Southern California Permanente Medical Group
Practice addresses (Care Compare)
1301 California St
Redlands, CA 92374-2910
Phone (909) 809-3222
2295 S Vineyard Ave
Ontario, CA 91761-7925
Phone (909) 724-5000
9961 Sierra Ave
Fontana, CA 92335-6720
Phone (909) 427-5000
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20070628000374 | CA | Practitioner - Optometry | 9931208170 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 11855T | CA | MD | Optometrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Southern California Permanente Medical Group | Current | Accepting new patients | |
| Southern California Permanente Medical Group | Current |
Accepting new patients | |
| James R. Dallas, O.D. | Optometrist | Current |
Accepting new patients |
| Southern California Permanente Medical Group | Current |
Accepting new patients |
Locations
1356 E Main St
Ste A
Barstow, CA 92311
Phone (760) 250-8014
9961 Sierra Ave
Fontana, CA 92335
Phone (909) 427-3910
393 E Walnut St
Fl 3
Pasadena, CA 91188
Phone (626) 405-7914
5601 De Soto Ave
Woodland Hls, CA 91367
Phone (818) 719-2000
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 11855T | CA | Yes |
Addresses
Primary practice location
1356 E Main St Ste a
Barstow, CA 92311-3241
Mailing address
1356 E Main St Ste a
Barstow, CA 92311-3241
Phone (760) 256-8014
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| SOAP URL | https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq | Health Information Exchange (HIE) | Southern California Permanente Medical Group |
Other providers in Barstow, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 1, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.