Individual provider Active NPI

Stevin R Minie, O.D.

  • Optometrist
  • Canoga Park, CA
National Provider Identifier
1629142278
Registry record updated Jul 9, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
09166T Issued in CA
Practice address
8391 Topanga Canyon Blvd
Canoga Park, CA 91304-2343
Phone
(818) 363-7828
NPI assigned
Nov 17, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 9, 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 09166T CA Primary

Addresses

Primary practice location

8391 Topanga Canyon Blvd
Canoga Park, CA 91304-2343

Mailing address

13010 Barto Dr
Granada Hills, CA 91344-1203
Phone (818) 363-7828

Other identifiers 1

IdentifierTypeStateIssuer
SD0091660MedicaidCA

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
I20040408001330 CA Practitioner - Optometry 3476546136 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Other, 1988
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Fyidoctors of California IncGroup PAC ID 3577961572, 21 clinicians

Practice addresses (Care Compare)

3808 W Riverside Dr
Suite 100
Burbank, CA 91505-4339
Phone (818) 843-2214

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
09166TCAMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Fyidoctors of California, Inc. Optometrist CurrentSince Apr 1, 2022 Accepting new patients

Locations

3808 W Riverside Dr
Ste 100
Burbank, CA 91505
Phone (818) 843-2214

114 N Sunrise Ave
Ste C4
Roseville, CA 95661
Phone (916) 786-2212

8391 Topanga Canyon Blvd
West Hills, CA 91304
Phone (818) 348-4666

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": "1163721600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1629142278",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13010 BARTO DR",
            "city": "GRANADA HILLS",
            "state": "CA",
            "postal_code": "913441203",
            "telephone_number": "818-363-7828"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8391 TOPANGA CANYON BLVD",
            "city": "CANOGA PARK",
            "state": "CA",
            "postal_code": "913042343",
            "telephone_number": "818-363-7828"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MINIE",
        "first_name": "STEVIN",
        "middle_name": "R",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-11-17",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "09166T",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "SD0091660",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Canoga Park, CA

Sources for this page

Verify at the official NPI Registry.