Active NPI
Tony Carnevali, O.D.
- Optometrist
- Los Angeles, CA
National Provider Identifier
1760479497
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 5827TPL
- Practice address
- 3916 S Broadway
Los Angeles, CA 90037-1307 - Phone
- (323) 234-9137
- Fax
- (323) 235-6203
- NPI assigned
- Sep 27, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 5827TPL | CA | Primary |
Addresses
Primary practice location
3916 S Broadway
Los Angeles, CA 90037-1307
Mailing address
3916 S Broadway
Los Angeles, CA 90037-1307
Phone (323) 234-9137
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| ZZT11740F | Medicaid | CA |
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5827TPL | CA | MD | Optometrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1127779200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1291852800000",
"number": "1760479497",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3916 S BROADWAY",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900371307",
"telephone_number": "323-234-9137",
"fax_number": "323-235-6203"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3916 S BROADWAY",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900371307",
"telephone_number": "323-234-9137",
"fax_number": "323-235-6203"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CARNEVALI",
"first_name": "TONY",
"name_prefix": "Dr.",
"credential": "O.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-09-27",
"last_updated": "2010-12-09",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "CA",
"license": "5827TPL",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "ZZT11740F",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Los Angeles, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 9, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.