Legacy Optometry | |
600 Ash St, Susanville, CA 96130-3714 | |
(530) 257-4424 | |
(530) 237-0426 |
Full Name | Legacy Optometry |
---|---|
Type | Facility |
Speciality | Optometrist |
Location | 600 Ash St, Susanville, California |
Accepts Medicare Assignments | Medicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1326660960 | NPI | - | NPPES |
V33674 | Other | NV | NORIDIAN |
002516454 | Medicaid | NV |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
152W00000X | Optometrist | (* (Not Available)) | Primary |
Provider Name | Joseph Pruitt |
---|---|
Provider Type | Practitioner - Optometry |
Provider Identifiers | NPI Number: 1477752913 PECOS PAC ID: 8921187477 Enrollment ID: I20080508000415 |
Provider Name | Barbara Searson |
---|---|
Provider Type | Practitioner - Optometry |
Provider Identifiers | NPI Number: 1215065065 PECOS PAC ID: 9931263605 Enrollment ID: I20111110000682 |
Provider Name | Anika Ramolia |
---|---|
Provider Type | Practitioner - Optometry |
Provider Identifiers | NPI Number: 1205084787 PECOS PAC ID: 0446398945 Enrollment ID: I20120222000284 |
Provider Name | Sheryl Reaves |
---|---|
Provider Type | Practitioner - Optometry |
Provider Identifiers | NPI Number: 1023301280 PECOS PAC ID: 7315194826 Enrollment ID: I20120905000464 |
Provider Name | Karen Mohar Sanghera |
---|---|
Provider Type | Practitioner - Optometry |
Provider Identifiers | NPI Number: 1467884817 PECOS PAC ID: 0446477798 Enrollment ID: I20140808001673 |
Provider Name | Teresa Pham |
---|---|
Provider Type | Practitioner - Optometry |
Provider Identifiers | NPI Number: 1376685966 PECOS PAC ID: 7214249309 Enrollment ID: I20150702000010 |
Provider Name | Lilan Le |
---|---|
Provider Type | Practitioner - Optometry |
Provider Identifiers | NPI Number: 1104230200 PECOS PAC ID: 9032413125 Enrollment ID: I20160210001606 |
Provider Name | Linda Shi |
---|---|
Provider Type | Practitioner - Optometry |
Provider Identifiers | NPI Number: 1700301231 PECOS PAC ID: 4688940679 Enrollment ID: I20180806000016 |
Provider Name | Magdalena Fuentes |
---|---|
Provider Type | Practitioner - Optometry |
Provider Identifiers | NPI Number: 1932617909 PECOS PAC ID: 3173864428 Enrollment ID: I20190415000573 |
Provider Name | Bradley Habermehl |
---|---|
Provider Type | Practitioner - Optometry |
Provider Identifiers | NPI Number: 1356375463 PECOS PAC ID: 2365443314 Enrollment ID: I20191024002308 |
Provider Name | Ariel J Esquibel |
---|---|
Provider Type | Practitioner - Optometry |
Provider Identifiers | NPI Number: 1023503810 PECOS PAC ID: 3678814613 Enrollment ID: I20191111001880 |
Provider Name | Troy M Humphreys |
---|---|
Provider Type | Practitioner - Ophthalmology |
Provider Identifiers | NPI Number: 1992712194 PECOS PAC ID: 3779622006 Enrollment ID: I20200730000973 |
Provider Name | James Herzman |
---|---|
Provider Type | Practitioner - Optometry |
Provider Identifiers | NPI Number: 1982764304 PECOS PAC ID: 8022168103 Enrollment ID: I20210126002509 |
Provider Name | Jenny Michelle Soo Hoo |
---|---|
Provider Type | Practitioner - Optometry |
Provider Identifiers | NPI Number: 1124401427 PECOS PAC ID: 1850605767 Enrollment ID: I20210203002562 |
Provider Name | Hemali B. Jardosh |
---|---|
Provider Type | Practitioner - Optometry |
Provider Identifiers | NPI Number: 1144537218 PECOS PAC ID: 6709066558 Enrollment ID: I20230228002055 |
Provider Name | Christeen Min |
---|---|
Provider Type | Practitioner - Optometry |
Provider Identifiers | NPI Number: 1275703068 PECOS PAC ID: 3173710837 Enrollment ID: I20230228002410 |
Provider Name | Dena Shahani |
---|---|
Provider Type | Practitioner - Optometry |
Provider Identifiers | NPI Number: 1134533953 PECOS PAC ID: 8123404274 Enrollment ID: I20230315001609 |
Provider Name | Selvin Gnanakkan |
---|---|
Provider Type | Practitioner - Optometry |
Provider Identifiers | NPI Number: 1104980846 PECOS PAC ID: 1456317510 Enrollment ID: I20230316002551 |
Provider Name | Jennifer Gipp |
---|---|
Provider Type | Practitioner - Optometry |
Provider Identifiers | NPI Number: 1154520666 PECOS PAC ID: 8729189899 Enrollment ID: I20230508001363 |
Provider Name | Mehreen Zia |
---|---|
Provider Type | Practitioner - Optometry |
Provider Identifiers | NPI Number: 1093269524 PECOS PAC ID: 0042550238 Enrollment ID: I20231026002235 |
Provider Name | Priscilla Lee |
---|---|
Provider Type | Practitioner - Optometry |
Provider Identifiers | NPI Number: 1235126129 PECOS PAC ID: 5092790592 Enrollment ID: I20240223000453 |
Provider Name | Adam Glover |
---|---|
Provider Type | Practitioner - Optometry |
Provider Identifiers | NPI Number: 1215586706 PECOS PAC ID: 8729426713 Enrollment ID: I20240425001895 |
Mailing Address | Practice Location Address |
---|---|
Legacy Optometry 600 Ash St, Susanville, CA 96130-3714 Ph: (530) 257-4424 | Legacy Optometry 600 Ash St, Susanville, CA 96130-3714 Ph: (530) 257-4424 |
Dr. Gregory A Boomer, Optometrist Medicare: Medicare Enrolled Practice Location: 607 A Cottage St, Susanville, CA 96130 Phone: 530-257-4424 Fax: 530-257-9626 | |
Dr. Martin G Hlusak, OD Optometrist Medicare: Not Enrolled in Medicare Practice Location: 914 Main St, Susanville, CA 96130 Phone: 530-257-2225 Fax: 530-257-2225 | |
Richard Marason, O.D. Optometrist Medicare: Medicare Enrolled Practice Location: 600 Ash St, Susanville, CA 96130 Phone: 530-257-3636 Fax: 530-257-7194 |