Organization Active NPI

Shakeh Bagdassar Eye to Eye Optometry

  • Optometrist
  • Glendale, CA
National Provider Identifier
1659867901
Registry record updated Jul 10, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
9792T Issued in CA
Legal business name
SHAKEH BAGDASSAR EYE TO EYE OPTOMETRY
Practice address
1101 N Pacific Ave Ste 105
Glendale, CA 91202-4314
Phone
(818) 243-1111
NPI assigned
Jul 10, 2018
Last updated
Jul 10, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 10, 2018

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

Authorized official

Name
Dr. Shakeh Bagdassar, O.D.NPI 1578672234
Title
Owner/ Optometrist
Phone
(818) 243-1111

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X 9792T CA Primary

Addresses

Primary practice location

1101 N Pacific Ave Ste 105
Glendale, CA 91202-4314

Mailing address

1101 N Pacific Ave Ste 105
Glendale, CA 91202-4314
Phone (818) 243-1111

Other identifiers 1

IdentifierTypeStateIssuer
SD0097920MedicaidCA

National Provider Directory

National Provider Directory

Locations

1101 N Pacific Ave
Ste 105
Glendale, CA 91202
Phone (818) 243-1111

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1531180800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1531180800000",
    "number": "1659867901",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1101 N PACIFIC AVE STE 105",
            "city": "GLENDALE",
            "state": "CA",
            "postal_code": "912024314",
            "telephone_number": "818-243-1111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1101 N PACIFIC AVE STE 105",
            "city": "GLENDALE",
            "state": "CA",
            "postal_code": "912024314",
            "telephone_number": "818-243-1111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHAKEH BAGDASSAR EYE TO EYE OPTOMETRY",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-07-10",
        "last_updated": "2018-07-10",
        "status": "A",
        "authorized_official_last_name": "BAGDASSAR",
        "authorized_official_first_name": "SHAKEH",
        "authorized_official_title_or_position": "OWNER/ OPTOMETRIST",
        "authorized_official_telephone_number": "818-243-1111",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "CA",
            "license": "9792T",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "SD0097920",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Glendale, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 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.

Verify at the official NPI Registry.