Individual provider Active NPI

Roya Manavi-Makhani, OPTOMETRIST

  • Optometrist
  • Los Angeles, CA
National Provider Identifier
1750431789
Registry record updated Oct 15, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
10510T Issued in CA
Practice address
1312 Montana Ave.
Los Angeles, CA 90403
Phone
(131) 057-6919
Fax
(131) 065-6685
NPI assigned
Jan 11, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 15, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 10510T CA Primary

Addresses

Primary practice location

1312 Montana Ave.
Los Angeles, CA 90403

Mailing address

12901 Benvenue St
Los Angeles, CA 90049-4821
Phone (131) 045-1220

Other identifiers 1

IdentifierTypeStateIssuer
SD0105100MedicaidCA

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
I20130620000219 CA Practitioner - Optometry 5799924825 Practice locations: Santa Monica, CA

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
10510TCAMDOptometrist
10510CAMDPhysical Therapist

NPI Registry JSON

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

{
    "created_epoch": "1168473600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1287100800000",
    "number": "1750431789",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12901 BENVENUE ST",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900494821",
            "telephone_number": "131-045-1220"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1312 MONTANA AVE.",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "90403",
            "telephone_number": "131-057-6919",
            "fax_number": "131-065-6685"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANAVI-MAKHANI",
        "first_name": "ROYA",
        "name_prefix": "Dr.",
        "credential": "OPTOMETRIST",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-11",
        "last_updated": "2010-10-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "10510T",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "SD0105100",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Los Angeles, CA

Sources for this page

Verify at the official NPI Registry.