Individual provider Active NPI

Jennifer Tabiza, O.D.

  • Optometrist
  • Los Angeles, CA
National Provider Identifier
1629209085
Registry record updated Jun 13, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
13816 Issued in CA
Practice address
8610 S Sepulveda Blvd
Ste 100
Los Angeles, CA 90045-4008
Phone
(310) 670-1888
Fax
(310) 670-1343
NPI assigned
Aug 3, 2009
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 13, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 13816 CA Primary

Addresses

Primary practice location

8610 S Sepulveda Blvd
Ste 100
Los Angeles, CA 90045-4008

Mailing address

8610 S Sepulveda Blvd
Ste 100
Los Angeles, CA 90045-4008
Phone (310) 670-1888

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
I20100120000555 CA Practitioner - Optometry 8527100130 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Other, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

8610 S Sepulveda Blvd
Suite 100
Los Angeles, CA 90045-4009
Phone (310) 670-1888

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
13816CAMDOptometrist

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": "1249257600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1465776000000",
    "number": "1629209085",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8610 S SEPULVEDA BLVD",
            "address_2": "STE 100",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900454008",
            "telephone_number": "310-670-1888",
            "fax_number": "310-670-1343"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8610 S SEPULVEDA BLVD",
            "address_2": "STE 100",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900454008",
            "telephone_number": "310-670-1888",
            "fax_number": "310-670-1343"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TABIZA",
        "first_name": "JENNIFER",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-08-03",
        "last_updated": "2016-06-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "13816",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Los Angeles, CA

Sources for this page

Verify at the official NPI Registry.