Eric Bass, O.D.
Individual provider Active NPI Optometrist · Westminster, CA
NPI 1780765289 · NPPES record last updated Apr 8, 2015
Key facts
- NPI
- 1780765289
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Optometrist 152W00000X
- License
- 8249T (CA)
- Practice address
- 15068 Goldenwest St
Westminster, CA 92683-6152 - Phone
- (714) 898-5631
- Fax
- (714) 898-6576
- NPI assigned
- Oct 18, 2006
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 3
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20070427000246 | CA | Practitioner - Optometry | 9830159003 |
Reassigns benefits to 1 organization Receives reassigned benefits from 1 practitioner Practice locations: Orange, CA |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 8249T | CA | MD | Optometrist |
| 8249 | CA | MD | Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Fourth Optometric Care of California | Optometrist | Current |
Accepting new patients |
| Fourth Optometric Care of California | Optometrist | Current | Accepting new patients |
| Fourth Optometric Care of California | Optometrist | Current |
Accepting new patients |
Locations
946 Manhattan Beach Blvd
Manhattan Beach, CA 90266
Phone (310) 545-4585
130 S Main St
Ste F
Orange, CA 92868
Phone (714) 939-9202
130 S Main St
Orange, CA 92868
Phone (714) 939-9202
3333 Quality Dr
Rncho Cordova, CA 95670
Phone (704) 712-0564
4505 Sepulveda Blvd
Torrance, CA 90505
Phone (310) 792-2020
15068 Goldenwest St
Westminster, CA 92683
Phone (714) 898-5631
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 8249T | CA | Yes |
Addresses
Primary practice location
15068 Goldenwest St
Westminster, CA 92683-6152
Mailing address
15068 Goldenwest St
Westminster, CA 92683-6152
Phone (714) 898-5631
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| SD0082490 | Medicaid | CA | |
| OP8249A | Other | CA | PPIN |
Other providers in Westminster, CA
- Amreen Banu
- Theresa Barnes
- Christopher J Barretto
- Khristine Gabrielle Bartolome
- Michele Barton
- Michelle Elise Christianne Bastin
- Beach Medical Management Inc.
- Beachcardiologymed.Group Inc.,
- Karen L Beaty
- Sophia Belanger
All providers in Westminster, CA · Optometrist in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 8, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.