Ronald V. Black, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

OPT9869T Issued in CA

Practice address

330 N Brand Blvd
Suite 110
Glendale, CA 91203-2308

Phone

(818) 240-0890

Fax

(818) 246-2540

NPI assigned

Jun 15, 2006

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

Other identifiers 4

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

Specialty

Optometry

Education

University of California - School of Optometry, 1992

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Brand Optometry a Prof CorpGroup PAC ID 3870025513, 5 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: ronald.black.1@17363.direct.athenahealth.com

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.

• Brand Optometry a Prof Corp

  • Optometrist
  • Glendale, CA
  • NPI 1629803168

  CA

  Medicare reassignment Care Compare group
• Advanced Eyecare Professional Optometric Group

  • Optometrist
  • Glendale, CA
  • NPI 1306035118
  NPD Authorized official
• Dr. Movses D'Janbatian, OD, Inc.

  • Optometrist
  • Glendale, CA
  • NPI 1053503581

  CA

  Medicare reassignment
• Craig Anthony Lenz

  • Podiatrist
  • Stockton, CA
  • NPI 1538170204
  NPD (past)
• Physicians Network Services Medical Group

  • Optometrist
  • Placentia, CA
  • NPI 1457445215
  NPD (past)

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

{
    "created_epoch": "1150329600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1253491200000",
    "number": "1821032442",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "330 N BRAND BLVD",
            "address_2": "SUITE 110",
            "city": "GLENDALE",
            "state": "CA",
            "postal_code": "91203",
            "telephone_number": "818-240-0890",
            "fax_number": "818-246-2540"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "330 N BRAND BLVD",
            "address_2": "SUITE 110",
            "city": "GLENDALE",
            "state": "CA",
            "postal_code": "912032308",
            "telephone_number": "818-240-0890",
            "fax_number": "818-246-2540"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLACK",
        "first_name": "RONALD",
        "middle_name": "V.",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-06-15",
        "last_updated": "2009-09-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "OPT9869T",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1306035118",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1821032442",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OPTOMETRY LICENSE",
            "identifier": "OPT9869T",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DME MACS PTAN",
            "identifier": "6191070001",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Biomed Lab
• James Birks III
• Susanne Semler Birman, R.N., C.N.S.
• Anthony James Bishop, LMFT
• Armine Bislamyan, PA-C
• Anne Blackstock-Bernstein
• Blanca F Bradley, Licensed Clinical Social Worker, Prof. Corp
• Felipe Blanco, RN
• Stephanie Janice Blanks, NP
• Diana Blegen-St. John, CCC-SLP

• All providers in Glendale, CA
• Optometrist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 21, 2009; 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.