Individual provider Active NPI

Luis Alfonso Molina, OD

  • Optometrist
  • San Diego, CA
National Provider Identifier
1902052590
Registry record updated Oct 24, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
13595 TPA Issued in CA
Practice address
1809 National Ave
San Diego, CA 92113-2113
Phone
(619) 515-2300
NPI assigned
Aug 14, 2008
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 24, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 13595 TPA CA Primary

Addresses

Primary practice location

1809 National Ave
San Diego, CA 92113-2113

Mailing address

823 Gateway Center Way
San Diego, CA 92102-4541
Phone (619) 515-2300

Other identifiers 1

IdentifierTypeStateIssuer
W5352OtherCACORPORATE UPIN

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
I20080922000419 CA Practitioner - OptometryPractitioner - Ophthalmology 0749357408 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Other, 1986
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1809 National Ave
San Diego, CA 92113-2113
Phone (619) 515-2300

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
13595 TPACAMDOptometrist
13595CAMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Family Health Centers of San Diego, Inc CurrentSince Mar 31, 2016 Accepting new patients
Family Health Centers of San Diego Inc Current Accepting new patients
Family Health Centers of San Diego, Inc Current Accepting new patients
Family Health Centers of San Diego, Inc CurrentSince Mar 31, 2016 Accepting new patients
Family Health Centers of San Diego Inc Current Accepting new patients

Locations

823 Gateway Center Way
San Diego, CA 92102
Phone (619) 515-2323

1809 National Ave
San Diego, CA 92113
Phone (619) 515-2500

Organizations & group practices 5

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": "1218672000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1729728000000",
    "number": "1902052590",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "823 GATEWAY CENTER WAY",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921024541",
            "telephone_number": "619-515-2300",
            "fax_number": "619-232-1360"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1809 NATIONAL AVE",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921132113",
            "telephone_number": "619-515-2300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOLINA",
        "first_name": "LUIS",
        "middle_name": "ALFONSO",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-08-14",
        "last_updated": "2024-10-24",
        "certification_date": "2024-10-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "13595 TPA",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CORPORATE UPIN",
            "identifier": "W5352",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in San Diego, CA

Sources for this page

Verify at the official NPI Registry.