Gallup Eye Group LLC

Primary specialty

OptometristTaxonomy code 152W00000X

Legal business name

GALLUP EYE GROUP LLC

Practice address

816 Boardman Dr
Gallup, NM 87301-4711

Phone

(505) 339-2015

Fax

(505) 492-0904

NPI assigned

Jul 26, 2018

Organization subpart

No

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

Authorized official

Name

Dr. Brandi McGraw, ODNPI 1861631293

Title

President/OD

Phone

(505) 339-2015

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in NM

Enrollment records 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Brandi Nichole Smith McGraw, O.D.

  • Optometrist
  • Gallup, NM
  • NPI 1861631293
  Medicare reassignment Care Compare group NPD Authorized official
• Matthew David McGraw, OD

  • Optometrist
  • Gallup, NM
  • NPI 1558599217
  Medicare reassignment Care Compare group NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1532563200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1610236800000",
    "number": "1073090650",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "816 BOARDMAN DR",
            "city": "GALLUP",
            "state": "NM",
            "postal_code": "873014711",
            "telephone_number": "505-339-2015",
            "fax_number": "505-492-0904"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "816 BOARDMAN DR",
            "city": "GALLUP",
            "state": "NM",
            "postal_code": "873014711",
            "telephone_number": "505-339-2015",
            "fax_number": "505-492-0904"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GALLUP EYE GROUP LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-07-26",
        "last_updated": "2021-01-10",
        "certification_date": "2021-01-10",
        "status": "A",
        "authorized_official_last_name": "MCGRAW",
        "authorized_official_first_name": "BRANDI",
        "authorized_official_title_or_position": "PRESIDENT/OD",
        "authorized_official_telephone_number": "505-339-2015",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "525331",
            "state": "AZ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "16438311",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• John Thomas Gallagher, RN
• Gallup Cardiology PC
• Gallup Child and Family Counseling
• Gallup Community Health
• Gallup Dental Group
• Gallup Health Facilities LP
• Gallup Indian Med Center Pharmacy
• Gallup Indian Medical Center
• Gallup Indian Medical Center
• Gallup Limb and Brace Co Inc

• Optometrist in Gallup, NM
• Providers in Gallup, NM by specialty
• Optometrist in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 10, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.