Active NPI
Courique Optical
- Ophthalmology Physician
- San Diego, CA
National Provider Identifier
1821312190
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Ophthalmology Physician
- License
- 4401850001
- Legal business name
- COURIQUE OPTICAL
- Practice address
- 3969 4TH Ave
Suite 301
San Diego, CA 92103-3165 - Phone
- (619) 291-6191
- Fax
- (619) 291-0049
- NPI assigned
- Mar 16, 2010
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Dr. Michael T Couris, MD
- Title
- Owner
- Phone
- (619) 291-6191
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Ophthalmology Physician | 207W00000X | 4401850001 | CA | Primary |
Addresses
Primary practice location
3969 4TH Ave
Suite 301
San Diego, CA 92103-3165
Mailing address
3969 4TH Ave
Suite 301
San Diego, CA 92103-3165
Phone (619) 291-6191
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00A532650 | Medicaid | CA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20100930008184 | CA | DME Supplier - Physician - General Practice | 4082814413 |
1 other NPI on this enrollment Practice locations: San Diego, CA |
Other NPIs on the same Medicare enrollment 1
NPIs listed together on one Medicare enrollment, typically parts of the same organization.
National Provider Directory
National Provider DirectoryNPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1268697600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1273190400000",
"number": "1821312190",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3969 4TH AVE",
"address_2": "SUITE 301",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921033165",
"telephone_number": "619-291-6191",
"fax_number": "619-291-0049"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3969 4TH AVE",
"address_2": "SUITE 301",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921033165",
"telephone_number": "619-291-6191",
"fax_number": "619-291-0049"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "COURIQUE OPTICAL",
"organizational_subpart": "NO",
"enumeration_date": "2010-03-16",
"last_updated": "2010-05-07",
"status": "A",
"authorized_official_last_name": "COURIS",
"authorized_official_first_name": "MICHAEL",
"authorized_official_middle_name": "T",
"authorized_official_title_or_position": "OWNER",
"authorized_official_telephone_number": "619-291-6191",
"authorized_official_name_prefix": "Dr.",
"authorized_official_credential": "MD"
},
"taxonomies": [
{
"code": "207W00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Ophthalmology",
"state": "CA",
"license": "4401850001",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00A532650",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}
Other providers in San Diego, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 7, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.