Active NPI
Ted Kiyotoshi Nishimura, O.D.
- Optometrist
- Burbank, CA
National Provider Identifier
1912279787
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 10983T
- Practice address
- 1051 W Burbank Blvd
Burbank, CA 91506-1421 - Phone
- (818) 841-7055
- Fax
- (818) 841-7058
- NPI assigned
- Feb 8, 2012
- 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 | 10983T | CA | Primary |
Addresses
Primary practice location
1051 W Burbank Blvd
Burbank, CA 91506-1421
Mailing address
5175 Dawes Ave
Culver City, CA 90230-6011
Phone (310) 398-9076
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 10983T | CA | MD | Optometrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1328659200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1328659200000",
"number": "1912279787",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5175 DAWES AVE",
"city": "CULVER CITY",
"state": "CA",
"postal_code": "902306011",
"telephone_number": "310-398-9076"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1051 W BURBANK BLVD",
"city": "BURBANK",
"state": "CA",
"postal_code": "915061421",
"telephone_number": "818-841-7055",
"fax_number": "818-841-7058"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NISHIMURA",
"first_name": "TED",
"middle_name": "KIYOTOSHI",
"name_prefix": "Dr.",
"credential": "O.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2012-02-08",
"last_updated": "2012-02-08",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "CA",
"license": "10983T",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Burbank, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 8, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.