Active NPI
Ellen Shuham, OD
- Optometrist
- Northridge, CA
National Provider Identifier
1629127519
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- OPT6899TPA
- Practice address
- 18661 Devonshire St
Northridge, CA 91324 - Phone
- (818) 368-1234
- Fax
- (818) 363-3161
- NPI assigned
- Jan 9, 2007
- Sex
- Female
- Sole proprietor
- No
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 | OPT6899TPA | CA | Primary |
Addresses
Primary practice location
18661 Devonshire St
Northridge, CA 91324
Mailing address
18661 Devonshire St
Northridge, CA 91324
Phone (818) 368-1234
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| SD0068990 | 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 |
|---|---|---|---|
| OPT6899TPA | CA | MD | Optometrist |
| 6899 | CA | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1168300800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1258416000000",
"number": "1629127519",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "18661 DEVONSHIRE ST",
"city": "NORTHRIDGE",
"state": "CA",
"postal_code": "91324",
"telephone_number": "818-368-1234",
"fax_number": "818-363-3161"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "18661 DEVONSHIRE ST",
"city": "NORTHRIDGE",
"state": "CA",
"postal_code": "91324",
"telephone_number": "818-368-1234",
"fax_number": "818-363-3161"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHUHAM",
"first_name": "ELLEN",
"credential": "OD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-01-09",
"last_updated": "2009-11-17",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "CA",
"license": "OPT6899TPA",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "SD0068990",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Northridge, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 17, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.