Alexis Makiko McCullough, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

34810 Issued in CA

Practice address

4353 La Jolla Village Dr Ste H-20
San Diego, CA 92122-1242

Phone

(858) 622-2165

NPI assigned

Jul 5, 2021

Last updated

Jul 5, 2021By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA, NE, WI, MN4 enrollments

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 4

Specialty

Optometry

Education

Southern California College of Optometry, 2020

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Total Vision PC

  dba Total Vision

  • Optometrist
  • San Diego, CA
  • NPI 1356813711
  Medicare reassignment NPD
• Troy Humphreys OD Faao, Professional Corporation

  dba Legacy Optometry

  • Optometrist
  • Susanville, CA
  • NPI 1326660960
  Medicare reassignment NPD
• Visionworks, Inc.

  dba Visionworks

  • Optometrist
  • Omaha, NE
  • NPI 1619006327
  Medicare reassignment NPD
• Visionworks, Inc.

  dba Visionworks

  • Optometrist
  • Austin, MN
  • NPI 1881962173
  Medicare reassignment NPD
• Eyemd on Cass a Professional Corporation

  • Optometrist
  • Monterey, CA
  • NPI 1205095742
  Medicare reassignment
• Myeyedr Optometry of Wisconsin, LLC

  dba MyEyeDr.

  • Optometrist
  • Kenosha, WI
  • NPI 1164992996
  Medicare reassignment
• Shoptikal LLC

  dba Shopko Optical 4002

  • Eyewear Supplier
  • Green Bay, WI
  • NPI 1659937159
  Medicare reassignment
• Myeyedr Optometry of Wisconsin, LLC

  dba MyEyeDr.

  • Optometrist
  • West Allis, WI
  • NPI 1710632864
  NPD
• Shoptikal LLC

  dba Fielmann Vision Care 4313

  • Eyewear Supplier
  • Rockford, IL
  • NPI 1467311142

  Optometrist

  NPD
• Shoptikal LLC

  dba Shopko Optical 4116

  • Eyewear Supplier
  • Sheboygan Falls, WI
  • NPI 1972169365

  Optometrist

  NPD
• Visionworks, Inc

  dba Visionworks

  • Eyewear Supplier
  • Simpsonville, SC
  • NPI 1699571166
  NPD
• Marina Eyecare Center

  dba Pacific EyeCare Center

  • Optometrist
  • Los Angeles, CA
  • NPI 1407917701
  NPD (past)

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

{
    "created_epoch": "1625443200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1625443200000",
    "number": "1942871645",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2556 CHICAGO ST UNIT 28",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921104161",
            "telephone_number": "310-480-0216"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4353 LA JOLLA VILLAGE DR STE H-20",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921221242",
            "telephone_number": "858-622-2165"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCCULLOUGH",
        "first_name": "ALEXIS",
        "middle_name": "MAKIKO",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-07-05",
        "last_updated": "2021-07-05",
        "certification_date": "2021-07-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "34810",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• David James McCulley, M.D.
• Lisa McCulloch
• Molly McCulloch
• Robert Corey McCulloch, PH.D.
• James Michael McCullock, CMT
• Amanda McCullough
• Deirdre Maureen McCullough, M.D.
• Jocelyn Colleen McCullough, M.A.
• Lynsi McCullough
• Priscilla Palicki McCullough

• Optometrist in San Diego, CA
• Providers in San Diego, CA by specialty
• Optometrist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 5, 2021; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.