Individual provider Active NPI

Jessica S Shoumer, O.D.

  • Optometrist
  • Sherman Oaks, CA
National Provider Identifier
1639302227
Registry record updated Jan 24, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
OPT 13743 TLG Issued in CA
Practice address
4454 Van Nuys Blvd Ste C
Sherman Oaks, CA 91403-5749
Phone
(818) 981-2489
NPI assigned
Aug 28, 2009
Last updated
Jan 24, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 24, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X OPT 13743 TLG CA Primary

Addresses

Primary practice location

4454 Van Nuys Blvd Ste C
Sherman Oaks, CA 91403-5749

Mailing address

4454 Van Nuys Blvd Ste C
Sherman Oaks, CA 91403-5749
Phone (818) 981-2489

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
I20100126000255 CA Practitioner - Optometry 3870635097 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
OPT 13743 TLGCAMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Luxottica of America Inc Past Accepting new patients
Craig W Hoeft Past Accepting new patients

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1251417600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1674518400000",
    "number": "1639302227",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4454 VAN NUYS BLVD STE C",
            "city": "SHERMAN OAKS",
            "state": "CA",
            "postal_code": "914035749",
            "telephone_number": "818-981-2489"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4454 VAN NUYS BLVD STE C",
            "city": "SHERMAN OAKS",
            "state": "CA",
            "postal_code": "914035749",
            "telephone_number": "818-981-2489"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHOUMER",
        "first_name": "JESSICA",
        "middle_name": "S",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-08-28",
        "last_updated": "2023-01-24",
        "certification_date": "2023-01-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "OPT 13743 TLG",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Sherman Oaks, CA

Sources for this page

Verify at the official NPI Registry.