Maneh Gevorgyan, OD
Individual provider Active NPI Optometrist · La Canada, CA
NPI 1962044404 · NPPES record last updated Mar 16, 2022
Key facts
- NPI
- 1962044404
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Optometrist 152W00000X
- License
- 34434 (CA)
- Practice address
- 845 Foothill Blvd
La Canada, CA 91011-3337 - Phone
- (818) 864-6461
- NPI assigned
- Oct 16, 2019
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare Care Compare profile
- Specialty
- Optometry
- Education
- Other, 2019
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Perception Optometry
Practice addresses (Care Compare)
845 Foothill Blvd
La Canada, CA 91011-3337
Phone (617) 257-3852
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20220128000442 | CA | Practitioner - Optometry | 6103218433 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Practice roles (1 of 2)
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Perception Optometry | Optometrist | Current |
Accepting new patients |
Locations
845 Foothill Blvd
La Canada Flintridge, CA 91011
Phone (818) 952-0172
Networks
- BSC 65 PLUS INDIVIDUAL MAPD
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 34434 | CA | Yes |
Addresses
Primary practice location
845 Foothill Blvd
La Canada, CA 91011-3337
Mailing address
2759 Hermosa Ave Apt 206
Montrose, CA 91020-1748
Phone (617) 257-3852
Other practice location 1
1601 W Verdugo Ave
Burbank, CA 91506-2101
Phone (617) 257-3852
Other providers in La Canada, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 16, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.