Individual provider Active NPI

Larry Lee Alenbaugh, O.P.T

  • Optometrist
  • Los Angeles, CA
National Provider Identifier
1881631885
Registry record updated Feb 25, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
OPT 12542T Issued in CA
Practice address
150 N Reno St
Los Angeles, CA 90026-4656
Phone
(323) 669-4326
Fax
(323) 953-3658
NPI assigned
May 31, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 25, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X OPT 12542T CA Primary

Addresses

Primary practice location

150 N Reno St
Los Angeles, CA 90026-4656

Mailing address

950 S Grand Ave FL 2
Los Angeles, CA 90015-3999
Phone (323) 669-4346

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20170106000413 CA Practitioner - Optometry 5294897922 Reassigns benefits to 1 organization
Practice locations: San Diego, CA

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
OPT 12542TCAMDOptometrist
12542CAMDPsychiatry Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Gracelight Community Health CurrentSince Feb 20, 2019 Accepting new patients
Gracelight Community Health CurrentSince Feb 20, 2019 Accepting new patients
Larry Alenbaugh Optometry Optometrist PastSince Dec 20, 2016 Accepting new patients
Children'S Hospital Los Angeles Mental Health Past Accepting new patients

Locations

950 S Grand Ave
Fl 2
Los Angeles, CA 90015

150 N Reno St
Los Angeles, CA 90026
Phone (213) 380-7298

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1149033600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1582588800000",
    "number": "1881631885",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "950 S GRAND AVE FL 2",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900153999",
            "telephone_number": "323-669-4346",
            "fax_number": "323-635-1891"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "150 N RENO ST",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900264656",
            "telephone_number": "323-669-4326",
            "fax_number": "323-953-3658"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ALENBAUGH",
        "first_name": "LARRY",
        "middle_name": "LEE",
        "name_prefix": "Dr.",
        "credential": "O.P.T",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-31",
        "last_updated": "2020-02-25",
        "certification_date": "2020-02-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "OPT 12542T",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Los Angeles, CA

Sources for this page

Verify at the official NPI Registry.