Amy J Walport, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

14018TLG Issued in CA

Practice address

12523 Limonite Ave Ste 460
Mira Loma, CA 91752-3668

Phone

(951) 685-9645

NPI assigned

Oct 5, 2010

Last updated

Oct 5, 2010By the provider in NPPES

Sex

Female

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 OR, CA2 enrollments

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 2

Specialty

Optometry

Education

Southern College of Optometry, 2010

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Siskiyou Eye Center Medical Group IncGroup PAC ID 6103996848, 6 clinicians

Siskiyou Eye Center, Medical Group, PCGroup PAC ID 5890685911, 6 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: amy@siskiyoueye.direct.eyemdemr.com

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.

• Siskiyou Eye Center, Medical Group, Inc

  dba Siskiyou Eye Center

  • Ophthalmology Physician
  • Yreka, CA
  • NPI 1144224577
  Medicare reassignment Care Compare group NPD
• Siskiyou Eye Center, Medical Group, PC

  dba Siskiyou Eye Center

  • Ophthalmology Physician
  • Ashland, OR
  • NPI 1275537987
  Medicare reassignment Care Compare group NPD
• Richard Garratt OD Inc

  dba San Dimas Optometry

  • Optometrist
  • San Dimas, CA
  • NPI 1457322737
  NPD (past)
• Suzan Burmayan, O.D., a Professional Corporation

  • Optometrist
  • San Dimas, CA
  • NPI 1245077155
  NPD (past)

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

{
    "created_epoch": "1286236800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1286236800000",
    "number": "1831408186",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1119 NEATHERLY CIR",
            "city": "CORONA",
            "state": "CA",
            "postal_code": "928801240",
            "telephone_number": "714-504-2789"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12523 LIMONITE AVE STE 460",
            "city": "MIRA LOMA",
            "state": "CA",
            "postal_code": "917523668",
            "telephone_number": "951-685-9645"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALPORT",
        "first_name": "AMY",
        "middle_name": "J",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2010-10-05",
        "last_updated": "2010-10-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "14018TLG",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sleep DME Management, Inc. (Sleep Billing Solutions)
• Sports Industrial Physical Therapy
• Tri-Industrial Medical Center
• Kristie Anh Vo, O.D
• Vons Companies Inc (Vons Pharmacy #2688)
• Jessie Marie Welch
• Elizabeth E Williamson, DDS

• Optometrist in Mira Loma, CA
• Providers in Mira Loma, CA by specialty
• Optometrist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 2010; 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.