Active NPI
Kevin Ikeda, OD
- Optometrist
- Santa Paula, CA
National Provider Identifier
1831166347
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 6465TLP
- Practice address
- 400 E Santa Barbara St
Suite C
Santa Paula, CA 93060-2675 - Phone
- (805) 525-6603
- Fax
- (805) 525-6115
- NPI assigned
- Mar 2, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 6465TLP | CA | Primary |
Addresses
Primary practice location
400 E Santa Barbara St
Suite C
Santa Paula, CA 93060-2675
Mailing address
400 E Santa Barbara St
Suite C
Santa Paula, CA 93060-2675
Phone (805) 525-6603
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| SD0064650 | Medicaid | CA | |
| OD00001232 | Other | WA | STATE OF WA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6465TLP | CA | MD | Optometrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Heritage Valley Eye Care Optometric Center | Optometrist | Past | Accepting new patients |
| Heritage Valley Eye Care Optometric Center | Optometrist | Past | Accepting new patients |
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 and National Provider Directory roles.
-
- Optometrist
- Santa Paula, CA
- NPI 1164497905
-
- Optometrist
- Fillmore, CA
- NPI 1336202225
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1141257600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1286409600000",
"number": "1831166347",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "400 E SANTA BARBARA ST",
"address_2": "SUITE C",
"city": "SANTA PAULA",
"state": "CA",
"postal_code": "930602675",
"telephone_number": "805-525-6603",
"fax_number": "805-525-6115"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "400 E SANTA BARBARA ST",
"address_2": "SUITE C",
"city": "SANTA PAULA",
"state": "CA",
"postal_code": "930602675",
"telephone_number": "805-525-6603",
"fax_number": "805-525-6115"
}
],
"practiceLocations": [],
"basic": {
"last_name": "IKEDA",
"first_name": "KEVIN",
"name_prefix": "Dr.",
"credential": "OD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-03-02",
"last_updated": "2010-10-07",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "CA",
"license": "6465TLP",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "SD0064650",
"state": "CA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE OF WA",
"identifier": "OD00001232",
"state": "WA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Santa Paula, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 7, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.