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DR. PAUL JONATHAN SUPER OD
NPI 1649499807
Optometrist in Los Angeles, CA

Active since April 25, 2007PECOS Enrolled
11696 SAN VICENTE BLVD, LOS ANGELES, CA 90049(310) 820-2020(310) 820-1884 Get Directions Write a Review

NPPES record last updated: December 23, 2020. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Dec 23, 2020, Mar 3, 2016 (2 updates tracked since 2016).

About Dr. Paul Jonathan Super Od NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. PAUL JONATHAN SUPER OD (NPI 1649499807) is an individual optometrist in Los Angeles, California, licensed in California (OPT8867) and active in the NPI registry since April 2007. He is enrolled in Medicare PECOS and maintains a secondary practice location in Los Angeles.

NPPES Registry Identity

NPI1649499807
Entity TypeIndividualMale
Primary Taxonomy152W00000X
Provider Legal NameDR. PAUL JONATHAN SUPERCredential: OD
Location Address11696 SAN VICENTE BLVDLos Angeles, CA 90049-5104
Mailing Address11696 San Vicente BlvdLos Angeles, CA 90049-5104 · (310) 820-2020 · Fax (310) 820-1884
Phone(310) 820-2020
Fax(310) 820-1884
Sole ProprietorNo
Enumeration DateApril 25, 2007
Last NPPES UpdateDecember 23, 20202 updates tracked since enumeration
NPPES CertifiedDecember 18, 2020
✔ NPI 1649499807 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyOptometristEye and Vision Services Providers
Taxonomy Code152W00000X
License✔ Licensed in CA · OPT8867
Definition
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.
Also ListedOptometrist · Corneal and Contact ManagementTaxonomy 152WC0802X · License OP8867TPG (CA)
11696 SAN VICENTE BLVD, Los Angeles, CA 90049
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Other Names 1

Other Name (5)Paul J Super Od

Secondary Practice Location 1

Location 12940 N Beverly Glen CirLos Angeles, CA 90077-1724 · Phone (310) 820-2020

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Blue Cross and Blue Shield of Montana, Blue Cross and Blue Shield of Oklahoma, Blue Cross and Blue Shield of Texas and more.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Dr. Paul Jonathan Super Od is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 90049 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$142.39 typical visit price
range $62.96 – $187.60
Typical copayment $35.59 (range $15.74 – $46.90)
Most-billed visit code 99204
Established Patient
$77.96 typical visit price
range $20.84 – $153.61
Typical copayment $19.49 (range $5.21 – $38.40)
Most-billed visit code 99213
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

JACQUELINE REYES OD
Optometrist
11696 SAN VICENTE BLVD
LOS ANGELES, CA 90049
Los Angeles County (310) 820-2020

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Paul Super's NPI number?

The NPI number for Paul Super is 1649499807. It was assigned to this individual provider in the NPPES registry on April 25, 2007. The provider is also known as Paul J Super Od.

Where is Paul Super located?

Paul Super practices at 11696 San Vicente Blvd, Los Angeles, CA 90049. The listed phone number is (310) 820-2020.

What is Paul Super's specialty?

The primary specialty registered for this NPI is Optometrist with taxonomy code 152W00000X.

Is Paul Super enrolled in Medicare?

Yes. Paul Super is registered in the Medicare PECOS enrollment system.

What insurance does Paul Super accept?

Health plans from Blue Cross and Blue Shield of Montana, Blue Cross and Blue Shield of Oklahoma, Blue Cross and Blue Shield of Texas and Providence Health Plan list Paul Super as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Paul Super was last updated on December 23, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.