Active NPI
David Paul Shibata
- Optometrist
- Anthem, AZ
National Provider Identifier
1841397973
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 1174
- Practice address
- 42201 N 41St Dr
Suite 144
Anthem, AZ 85086 - Phone
- (623) 551-9122
- Fax
- (623) 551-9120
- NPI assigned
- Sep 20, 2006
- Last updated
- Sep 7, 2011
- 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 | 1174 | AZ | Primary |
Addresses
Primary practice location
42201 N 41St Dr
Suite 144
Anthem, AZ 85086
Mailing address
42201 N 41St Dr
Suite 144
Anthem, AZ 85086
Phone (623) 551-9122
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in AZ
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1174 | AZ | MD | Homeopath |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| I DRS, Inc. | Optometrist | Current | Accepting new patients |
| Tom Sowash OD & Associates PC | Optometrist | Past | Accepting new patients |
| Visionworks Inc | Past | Accepting new patients | |
| Idrs Inc | Optometrist | Past | Accepting new patients |
Locations
42201 N 41st Dr
Ste 128
Anthem, AZ 85086
Phone (623) 551-9122
42201 N 41st Dr
Ste 144
Anthem, AZ 85086
Phone (623) 551-9122
Organizations & group practices 4
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158710400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1315353600000",
"number": "1841397973",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "42201 N 41ST DR",
"address_2": "SUITE 144",
"city": "ANTHEM",
"state": "AZ",
"postal_code": "85086",
"telephone_number": "623-551-9122",
"fax_number": "623-551-9120"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "42201 N 41ST DR",
"address_2": "SUITE 144",
"city": "ANTHEM",
"state": "AZ",
"postal_code": "85086",
"telephone_number": "623-551-9122",
"fax_number": "623-551-9120"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHIBATA",
"first_name": "DAVID",
"middle_name": "PAUL",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-09-20",
"last_updated": "2011-09-07",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "AZ",
"license": "1174",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Anthem, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 7, 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.