Individual provider Active NPI

William Ken Shiomi, OD

  • Optometrist
  • Carson, CA
National Provider Identifier
1720058811
Registry record updated Jun 10, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
5335T Issued in CA
Practice address
20700 S Avalon Blvd
Suite 343
Carson, CA 90746-3701
Phone
(310) 532-2622
NPI assigned
Jan 23, 2006
Last updated
Jun 10, 2008By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 10, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 5335T CA Primary

Addresses

Primary practice location

20700 S Avalon Blvd
Suite 343
Carson, CA 90746-3701

Mailing address

20700 S Avalon Blvd
Suite 343
Carson, CA 90746-3701
Phone (310) 532-2622

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
I20101105000259 CA Practitioner - Optometry 8921292772 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
5335CAMDCounselor

Practice roles

OrganizationSpecialtyStatusNew patients
William K. Shiomi, O.D., Inc Optometrist CurrentSince Aug 17, 2010 Accepting new patients
Alina Ho OD a Professional Corp Optometrist PastSince Jul 19, 2018 Accepting new patients

Locations

20700 Avalon Blvd
Ste 343
Carson, CA 90746
Phone (310) 532-2622

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

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, 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": "1137974400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1213056000000",
    "number": "1720058811",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20700 S AVALON BLVD",
            "address_2": "SUITE 343",
            "city": "CARSON",
            "state": "CA",
            "postal_code": "907463701",
            "telephone_number": "310-532-2622"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20700 S AVALON BLVD",
            "address_2": "SUITE 343",
            "city": "CARSON",
            "state": "CA",
            "postal_code": "907463701",
            "telephone_number": "310-532-2622"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHIOMI",
        "first_name": "WILLIAM",
        "middle_name": "KEN",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-01-23",
        "last_updated": "2008-06-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "5335T",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Carson, CA

Sources for this page

Verify at the official NPI Registry.