Individual provider Active NPI

Michael Mayeda, O.D.

  • Optometrist
  • Torrance, CA
National Provider Identifier
1972597250
Registry record updated Jul 25, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
8541T Issued in CA
Practice address
17430 Crenshaw Blvd
Suite B
Torrance, CA 90504-3400
Phone
(310) 532-8900
Fax
(310) 532-4079
NPI assigned
Sep 1, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 25, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 8541T CA Primary

Addresses

Primary practice location

17430 Crenshaw Blvd
Suite B
Torrance, CA 90504-3400

Mailing address

6102 Warwood Rd
Lakewood, CA 90713-3137

Other identifiers 1

IdentifierTypeStateIssuer
8541MedicaidCA

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
I20130201000398 CA Practitioner - Optometry 2062666860 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Southern California College of Optometry, 1986
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

17430 Crenshaw Blvd
Suite B
Torrance, CA 90504-3400

17430 Crenshaw Blvd B
Torrance, CA 90504-3400

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
8541TCAMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
North Torrance Optometry Optometrist PastSince Nov 28, 2012 Accepting new patients

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": "1125532800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1374710400000",
    "number": "1972597250",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6102 WARWOOD RD",
            "city": "LAKEWOOD",
            "state": "CA",
            "postal_code": "907133137"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17430 CRENSHAW BLVD",
            "address_2": "SUITE B",
            "city": "TORRANCE",
            "state": "CA",
            "postal_code": "905043400",
            "telephone_number": "310-532-8900",
            "fax_number": "310-532-4079"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAYEDA",
        "first_name": "MICHAEL",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-09-01",
        "last_updated": "2013-07-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "8541T",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8541",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Torrance, CA

Sources for this page

Verify at the official NPI Registry.