Individual provider Active NPI

Shermin Lahijani, O.D.

  • Optometrist
  • Los Angeles, CA
National Provider Identifier
1891764833
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
12319T Issued in CA
Practice address
2105 Beverly Blvd Ste 117
Los Angeles, CA 90057-2254
Phone
(323) 667-2102
Fax
(323) 927-1799
NPI assigned
Mar 14, 2006
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 12319T CA Primary

Addresses

Primary practice location

2105 Beverly Blvd Ste 117
Los Angeles, CA 90057-2254

Mailing address

2105 Beverly Blvd Ste 117
Los Angeles, CA 90057-2254
Phone (323) 667-2102

Other identifiers 1

IdentifierTypeStateIssuer
SD0123190MedicaidCA

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
I20040722001236 CA Practitioner - Optometry 6507846292 Practice locations: Los Angeles, CA

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
12319TCAMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Hollywood Optometrist Optometrist CurrentSince Dec 9, 2019 Accepting new patients
Hollywood Optometrist Optometrist CurrentSince Jun 21, 2020 Accepting new patients

Locations

1300 N Vermont Ave
Ste 703
Los Angeles, CA 90027
Phone (323) 667-2102

2105 Beverly Blvd
Ste 117
Los Angeles, CA 90057
Phone (213) 413-8742

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.

NPI Registry JSON

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

{
    "created_epoch": "1142294400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1891764833",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2105 BEVERLY BLVD STE 117",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900572254",
            "telephone_number": "323-667-2102",
            "fax_number": "323-927-1799"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2105 BEVERLY BLVD STE 117",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900572254",
            "telephone_number": "323-667-2102",
            "fax_number": "323-927-1799"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LAHIJANI",
        "first_name": "SHERMIN",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-03-14",
        "last_updated": "2022-07-21",
        "certification_date": "2020-06-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "12319T",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "SD0123190",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Los Angeles, CA

Sources for this page

Verify at the official NPI Registry.