Jonovan Ottenbacher, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

14235 Issued in CA

Practice address

6333 W 3Rd St
#708
Los Angeles, CA 90036-3109

Phone

(323) 936-5140

NPI assigned

Jul 27, 2011

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in HI

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

Specialty

Optometry

Education

University of Houston - College of Optometry, 2011

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Hawaii Permanente Medical Group IncGroup PAC ID 7618880667, 705 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Hawaii Permanente Medical Group Inc

  • Health Maintenance Organization
  • Honolulu, HI
  • NPI 1710945969
  Medicare reassignment Care Compare group NPD
• Global Eye and Laser

  • Customized Equipment (DME)
  • Los Angeles, CA
  • NPI 1306111356
  NPD (past)
• Global Eye and Laser Center

  • Optometrist
  • Los Angeles, CA
  • NPI 1942591367
  NPD (past)

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

{
    "created_epoch": "1311724800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1311724800000",
    "number": "1811275654",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6333 W 3RD ST",
            "address_2": "#708",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900363109",
            "telephone_number": "323-936-5140"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6333 W 3RD ST",
            "address_2": "#708",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900363109",
            "telephone_number": "323-936-5140"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OTTENBACHER",
        "first_name": "JONOVAN",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2011-07-27",
        "last_updated": "2011-07-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "14235",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tiana Otis
• Patricia Sherry Oto, INTERN PHARMACIST
• Joan Otomo-Corgel, DDS, MPH
• Otonix Inc
• Otosurgical Group Medical Clinic, Inc
• Rajani Lolita Ottley, LMFT
• Kristan Nicole Otto, R.D.A
• Peacillia Anwili Otuya
• Victoria Otuya
• Christian Ou, PA-C

• Optometrist in Los Angeles, CA
• Providers in Los Angeles, CA by specialty
• Optometrist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 27, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.