Individual provider Active NPI

Richard Palacios, O.D.

  • Optometrist
  • Northridge, CA
National Provider Identifier
1801000732
Registry record updated Mar 19, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
OPT12213 Issued in CA
Practice address
9301 Tampa Ave
Lenscrafter in Macys
Northridge, CA 91324-5656
Phone
(818) 341-3760
Fax
(818) 341-3745
NPI assigned
May 10, 2007
Last updated
Mar 19, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 19, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X VUT006119 NY
Optometrist 152W00000X OPT12213 CA Primary

Addresses

Primary practice location

9301 Tampa Ave
Lenscrafter in Macys
Northridge, CA 91324-5656

Mailing address

9301 Tampa Ave Unit 62
Northridge, CA 91324-5656
Phone (818) 885-7300

Other practice location 1

9301 Tampa Ave Unit 62
Northridge, CA 91324-5656
Phone (818) 885-7300

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
I20130412000093 CA Practitioner - Optometry 8022254390 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
OPT12213CAMDOptometrist
VUT006119NYMDOptometrist
12213CAMDSpecialist

Practice roles

OrganizationSpecialtyStatusNew patients
Richard Palacios OD, a Professional Corporation Optometrist CurrentSince Feb 4, 2013 Accepting new patients
Caroline Yokota, O.D., a Professional Corporation CurrentSince May 2, 2024 Accepting new patients

Locations

9301 Tampa Ave
Unit 62
Northridge, CA 91324
Phone (818) 885-7300

21918 Ventura Blvd
Woodland Hills, CA 91364
Phone (818) 888-5450

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": "1178755200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1710806400000",
    "number": "1801000732",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9301 TAMPA AVE UNIT 62",
            "city": "NORTHRIDGE",
            "state": "CA",
            "postal_code": "913245656",
            "telephone_number": "818-885-7300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9301 TAMPA AVE",
            "address_2": "LENSCRAFTER IN MACYS",
            "city": "NORTHRIDGE",
            "state": "CA",
            "postal_code": "913245656",
            "telephone_number": "818-341-3760",
            "fax_number": "818-341-3745"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "9301 Tampa Ave Unit 62",
            "address_purpose": "LOCATION",
            "city": "Northridge",
            "state": "CA",
            "postal_code": "913245656",
            "country_code": "US",
            "telephone_number": "818-885-7300",
            "fax_number": "818-709-2292",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PALACIOS",
        "first_name": "RICHARD",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-05-10",
        "last_updated": "2024-03-19",
        "certification_date": "2021-05-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NY",
            "license": "VUT006119",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "OPT12213",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Northridge, CA

Sources for this page

Verify at the official NPI Registry.