Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Nicole Koulisis, MD

Individual provider Ophthalmology Physician · NPI 1073033213

Nicole Koulisis, MD is an Ophthalmology in Encino, California. Qualified in 2017, 9 years ago. Practices with Retina Los Angeles, a 2-clinician group, works from 2 locations and accepts Medicare assignment. Licensed in California.

Years since qualifying
9
Licensed in
CA
In the registry since
2017
Specialties on file
2
What do these letters mean?
MD — Doctor of Medicine
A physician who completed allopathic medical school.

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Practice location Address checks out

5400 Balboa Blvd Ste 126
Encino, CA 91316-5202
Phone: (818) 578-0004
Fax: (818) 578-0002
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 1450 San Pablo St Ste 400, Los Angeles, CA 90033-5331 — (323) 442-6335

Specialties & licences

Retina Specialist (Ophthalmology) Physician (primary) Taxonomy 207WX0107X · Licence A157849 (CA)
Ophthalmology Physician Taxonomy 207W00000X · Licence A157849 (CA)

Record details

NPI number1073033213
Entity typeIndividual (Type 1)
GenderFemale
Credentials MD
Sole proprietorNo
NPI enumeratedJune 20, 2017
Last updated in NPPESDecember 1, 2022
Certification dateDecember 1, 2022

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyOPHTHALMOLOGY
Medical schoolOTHER
Graduated 2017 (9 years in practice)
Group practice Retina Los Angeles — 2 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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