Active NPI
Loren Baza, OD
- Optometrist
- Lake Worth, TX
National Provider Identifier
1649769985
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 9179TG
- Practice address
- 6014 Azle Ave Ste 200
Lake Worth, TX 76135-2603 - Phone
- (682) 312-2603
- NPI assigned
- May 2, 2018
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 9179T | TX | |
| Optometrist | 152W00000X | 9179TG | TX | Primary |
Addresses
Primary practice location
6014 Azle Ave Ste 200
Lake Worth, TX 76135-2603
Mailing address
1649 Sandle Wood Dr
Weatherford, TX 76087-1235
Other practice location 1
2644 East Berry Street
Fort Worth, TX 76105
Phone (817) 840-0847
Other practice location 2
4811 Overton Ridge Blvd
Fort Worth, TX 76132-1972
Phone (817) 432-8641
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 9179T | TX | MD | Optometrist |
| 9179TG | TX | MD | Optometrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| National Vision, Inc. | Past | Accepting new patients | |
| National Vision, Inc. | Past | Accepting new patients |
Organizations & group practices 2
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.
-
- Optician
- Lake Worth, TX
- NPI 1316300999
-
- Optician
- Fort Worth, TX
- NPI 1366935165
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1525219200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1530057600000",
"number": "1649769985",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1649 SANDLE WOOD DR",
"city": "WEATHERFORD",
"state": "TX",
"postal_code": "760871235"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6014 AZLE AVE STE 200",
"city": "LAKE WORTH",
"state": "TX",
"postal_code": "761352603",
"telephone_number": "682-312-2603"
}
],
"practiceLocations": [
{
"address_1": "2644 East Berry Street",
"address_purpose": "LOCATION",
"city": "Fort Worth",
"state": "TX",
"postal_code": "76105",
"country_code": "US",
"telephone_number": "817-840-0847",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "4811 Overton Ridge Blvd",
"address_purpose": "LOCATION",
"city": "Fort Worth",
"state": "TX",
"postal_code": "761321972",
"country_code": "US",
"telephone_number": "817-432-8641",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "BAZA",
"first_name": "LOREN",
"credential": "OD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-05-02",
"last_updated": "2018-06-27",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "TX",
"license": "9179T",
"primary": false
},
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "TX",
"license": "9179TG",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lake Worth, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 27, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.