Paul Jonathan Super, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

OPT8867 Issued in CA

Practice address

11696 San Vicente Blvd
Los Angeles, CA 90049-5104

Phone

(310) 820-2020

Fax

(310) 820-1884

NPI assigned

Apr 25, 2007

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other names 1

• Paul J Super Other name

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

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Golden Ardaya & Lin Optometry Inc

  • Optometrist
  • Whittier, CA
  • NPI 1962764340
  NPD
• David Rex Hamilton MD a PC

  • Ophthalmology Physician
  • Beverly Hills, CA
  • NPI 1871129734
  NPD (past)
• Regents Univ of Calif Los Angeles

  • Psychiatric Hospital
  • Los Angeles, CA
  • NPI 1952308363
  NPD (past)

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

{
    "created_epoch": "1177459200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1608681600000",
    "number": "1649499807",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11696 SAN VICENTE BLVD",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900495104",
            "telephone_number": "310-820-2020",
            "fax_number": "310-820-1884"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11696 SAN VICENTE BLVD",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900495104",
            "telephone_number": "310-820-2020",
            "fax_number": "310-820-1884"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2940 N Beverly Glen Cir",
            "address_purpose": "LOCATION",
            "city": "Los Angeles",
            "state": "CA",
            "postal_code": "900771724",
            "country_code": "US",
            "telephone_number": "310-820-2020",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SUPER",
        "first_name": "PAUL",
        "middle_name": "JONATHAN",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-04-25",
        "last_updated": "2020-12-23",
        "certification_date": "2020-12-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152WC0802X",
            "taxonomy_group": "",
            "desc": "Optometrist, Corneal and Contact Management",
            "state": "CA",
            "license": "OP8867TPG",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "OPT8867",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "PAUL",
            "last_name": "SUPER",
            "middle_name": "J",
            "credential": "OD",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Roddy Suos, PSYD
• Jocelyn Flordeliz Supan
• Janice Michelle Supe
• Super Care Diagnostic Services, Inc
• Super Kids ABA Center LLC
• Supercare Depot Inc
• Superior Hospitalist Medical Group Inc
• Superior Multi Specialty Medical Clinic Inc.
• Superpower Medical Group of Ca PC
• Supervista North America

• Optometrist in Los Angeles, CA
• Providers in Los Angeles, CA by specialty
• Optometrist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 23, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.