PAUL J SUPER OD A PROFESSIONAL CORPORATION (NPI# 1457681371) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1457681371 |
| Entity Type | Organization |
| Organization Name | PAUL J SUPER OD A PROFESSIONAL CORPORATION |
| Practice Address |
11777 San Vicente Blvd #130 Los Angeles CA 90049-5011 |
| Practice Telephone | 3108202020 |
| Practice Fax Number | 3108201884 |
| Mailing Telephone | 3108202020 |
| Mailing Fax Number | 3108201884 |
| Enumeration Date | 2009-12-29 |
| Last Update Date | 2016-03-03 |
| Authorized Official Name | DR. PAUL J SUPER (OPTOMETRIST) |
| Authorized Official Telephone | 3108202020 |
| Authorized Official Credential | O.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 302R00000X | Health Maintenance Organization | OPT8867T | CA | Managed Care Organizations |
| N | 152WV0400X |
Optometrist Specialization: Vision Therapy |
OP8867TPG | CA | Eye and Vision Services Providers |
| N | 152WP0200X |
Optometrist Specialization: Pediatrics |
OP8867TPG | CA | Eye and Vision Services Providers |
| N | 152WL0500X |
Optometrist Specialization: Low Vision Rehabilitation |
OP8867TPG | CA | Eye and Vision Services Providers |
| N | 152WC0802X |
Optometrist Specialization: Corneal and Contact Management |
OP8867TPG | CA | Eye and Vision Services Providers |
| Y | 152W00000X | Optometrist | OP8867TPG | CA | Eye and Vision Services Providers |
| Street Address |
11777 SAN VICENTE BLVD #130 |
| City | LOS ANGELES |
| State | CA |
| Zip Code | 90049-5011 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063401719 | Kelly Mui | Optometrist | 11777 San Vicente Blvd, Suite 130, Los Angeles, CA 90049-5011 | 2005-10-17 |
| 1457735953 | Sharon Tong | Optometrist | 11777 San Vicente Blvd, Ste 130, Los Angeles, CA 90049-5011 | 2015-07-14 |
| 1366700924 | Christina M Ford, Md | Psychiatry & Neurology | 11777 San Vicente Blvd, #703, Los Angeles, CA 90049-5011 | 2012-05-01 |
| 1255604146 | Lindsay Gail Alpert | Specialist | 11777 San Vicente Blvd, Suite 703, Los Angeles, CA 90049-5011 | 2012-02-22 |
| 1013100205 | Sharon Sears Dunas | Marriage & Family Therapist | 11777 San Vicente Blvd, Suite 703, Los Angeles, CA 90049 | 2007-08-22 |
| 1649499807 | Paul J Super | Optometrist | 11777 San Vicente Blvd, # 130, Los Angeles, CA 90049-5011 | 2007-04-25 |
| 1043389943 | Christina M Ford | Psychiatry & Neurology | 11777 San Vicente Blvd, #703, Los Angeles, CA 90049-5011 | 2006-11-06 |
| 1609959733 | Mimi Joy Curtis | Psychologist | 11777 San Vicente Blvd, Suite 703, Los Angeles, CA 90049-5011 | 2006-10-23 |
| 1730126509 | Leonard William Kram | Psychiatry & Neurology | 11777 San Vicente Blvd, #703, Los Angeles, CA 90049-5011 | 2006-06-01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316564339 | Kepp Family & Group Practice | Marriage & Family Therapist | 12011 San Vincente Blvd, 408, Los Angeles, CA 90049 | 2020-06-26 |
| 1386204493 | Steven J Lehrman | Marriage & Family Therapist | 179 S. Barrington Place, Office A, Los Angeles, CA 90049 | 2019-06-20 |
| 1922562990 | Jand. Inc. | Eyewear Supplier (Equipment, not the service) | 860 S. Sepulveda Blvd., Los Angeles, CA 90049 | 2019-01-24 |
| 1851864946 | Christie Schnur | Marriage & Family Therapist | 11911 San Vicente Blvd., Los Angeles, CA 90049 | 2019-01-10 |
| 1669954012 | Barbara Jiji Schenk | Marriage & Family Therapist | 520 S. Sepulveda Blvd #402, Los Angeles, CA 90049 | 2018-09-02 |
| 1972090710 | Community Reflections Inc | Counselor | 10020 So. Western Ave, 10020 So. Western Ave, Los Angeles, CA 90049 | 2018-04-17 |
| 1245738830 | Dr. Shirin Tabib LLC | Marriage & Family Therapist | 61133 San Vincent Blvd, Suite 318 A, Los Angeles, CA 90049 | 2018-01-29 |
| 1295240679 | Robert A Brooks | Preventive Medicine | 149 South Barrington Ave, #346, Los Angeles, CA 90049 | 2017-12-07 |
| 1598286478 | Marvin S Serrano | Physical Therapy Assistant | 11740 San Vicente Boulevard Suite 205, Los Angeles, CA 90049 | 2017-06-30 |
| 1972055812 | Evolve Growth Initiatives, LLC | Psychiatric Residential Treatment Facility | 820 Moraga Drive, Los Angeles, CA 90049 | 2016-10-26 |
| Find all providers in zip 90049 | ||||
| Taxonomy Code | 152W00000X |
| Grouping | Eye and Vision Services Providers |
| Classification | Optometrist |
| Doctors of optometry (ODs) are the primary health care professionals for the eye. Optometrists examine, diagnose, treat, and manage diseases, injuries, and disorders of the visual system, the eye, and associated structures as well as identify related systemic conditions affecting the eye. An optometrist has completed pre-professional undergraduate education in a college or university and four years of professional education at a college of optometry, leading to the doctor of optometry (O.D.) degree. Some optometrists complete an optional residency in a specific area of practice. Optometrists are eye health care professionals state-licensed to diagnose and treat diseases and disorders of the eye and visual system. |
| Notes: Source: American Optometric Association (AOA), approved by the AOA’s Board of Trustees, June 21, 2005. [7/1/2006: definition modified] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437766920 | Mary Mekhael | Optometrist | 5901 Center Dr Apt 456, Los Angeles, CA 90045-8969 | 2020-09-28 |
| 1013524677 | Jennifer Dang, O.d., A Professional Corporation | Optometrist | 301 S Western Ave Ste 103, Los Angeles, CA 90020-3816 | 2020-09-28 |
| 1467064766 | Quynh Trang Diep | Optometrist | 222 S Central Ave Apt 400, Los Angeles, CA 90012-4231 | 2020-08-18 |
| 1114547619 | Eyecare Specialists Medical Group, Inc. | Optometrist | 1711 W Temple St Ste 5665, Los Angeles, CA 90026-5421 | 2020-04-24 |
| 1487283362 | Daisy Lee Spearman | Optometrist | 5136 W Slauson Ave, Los Angeles, CA 90056-1641 | 2020-04-03 |
| 1376181768 | Nirlok Corporation | Optometrist | 750 West 7th Street, Los Angeles, CA 90017 | 2019-12-16 |
| 1841837242 | Hollywood Optometrist | Optometrist | 1300 N Vermont Ave Ste 703, Los Angeles, CA 90027-6089 | 2019-12-04 |
| 1770124570 | Manchester Optometry Eye Care | Optometrist | 10024 S Vermont Ave Ste 2, Los Angeles, CA 90044-3112 | 2019-10-02 |
| 1124588165 | Evelynne Chavez | Optometrist | 11301 Wilshire Blvd Bldg 304, Los Angeles, CA 90073-1003 | 2019-03-25 |
| 1467929265 | Galina Vardanyan | Optometrist | 621 S Western Ave Ste 214, Los Angeles, CA 90005 | 2018-10-30 |
| Find all providers in LOS ANGELES | ||||
| City | LOS ANGELES |
| Zip Code | 90049 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.