Dr. Taylor Bladh O.D. Inc

Primary specialty

OptometristTaxonomy code 152W00000X

Legal business name

DR. TAYLOR BLADH O.D. INC

Doing business as

Newport Harbor Optometry

Practice address

1796 Newport Blvd
Costa Mesa, CA 92627-2756

Phone

(949) 642-2020

Fax

(949) 642-8753

NPI assigned

Apr 25, 2019

Organization subpart

Yes

Parent organization

DR. TAYLOR BLADH O.D. INCAs reported in NPPES

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

Authorized official

Name

Dr. Taylor Woodbury Bladh, OD

Title

President

Phone

(909) 861-3737

Specialties & licenses 3

Addresses

Other identifiers 1

Other names 1

• Newport Harbor Optometry Doing business as

Tax ID family

Dr Taylor Bladh OD Inc2 organizations share this tax ID, including this one

Part of

Dr Taylor Bladh OD Inc

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Dr. Taylor Bladh O.D. Inc

  • Optometrist
  • Westminster, CA
  • NPI 1124424809
  NPD tax ID

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

{
    "created_epoch": "1556150400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1560211200000",
    "number": "1700440633",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1796 NEWPORT BLVD",
            "city": "COSTA MESA",
            "state": "CA",
            "postal_code": "926272756",
            "telephone_number": "949-642-2020"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1796 NEWPORT BLVD",
            "city": "COSTA MESA",
            "state": "CA",
            "postal_code": "926272756",
            "telephone_number": "949-642-2020",
            "fax_number": "949-642-8753"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DR. TAYLOR BLADH O.D. INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "DR. TAYLOR BLADH O.D. INC",
        "enumeration_date": "2019-04-25",
        "last_updated": "2019-06-11",
        "status": "A",
        "authorized_official_last_name": "BLADH",
        "authorized_official_first_name": "TAYLOR",
        "authorized_official_middle_name": "WOODBURY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "909-861-3737",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "152WC0802X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist, Corneal and Contact Management",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "152WP0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist, Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OPTOMETRY LICENSE NUMBER",
            "identifier": "OPT8921TPA",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Newport Harbor Optometry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Optometrist in Costa Mesa, CA
• Providers in Costa Mesa, CA by specialty
• Optometrist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2019; 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.