Nicole Lee Gates

Primary specialty

OptometristTaxonomy code 152W00000X

License

OPT.007033 Issued in OH

Practice address

30652 Red Rock CT
Logan, OH 43138-9670

Phone

(740) 385-4006

NPI assigned

May 23, 2022

Last updated

May 23, 2022By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in OH

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Optometry

Education

Indiana University - School of Optometry, 2022

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Holzer Clinic LLCGroup PAC ID 5890606008, 266 clinicians

Buckeye Vision Care IncGroup PAC ID 5799780763, 4 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Buckeye Vision Care Inc.

  • Optometrist
  • Logan, OH
  • NPI 1790889491
  Medicare reassignment Care Compare group NPD
• Holzer Clinic, LLC

  • Multi-Specialty Clinic/Center
  • Gallipolis, OH
  • NPI 1508817248
  Medicare reassignment Care Compare group

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

{
    "created_epoch": "1653264000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1653264000000",
    "number": "1073251708",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "673 W WASHINGTON ST",
            "city": "NELSONVILLE",
            "state": "OH",
            "postal_code": "457649745",
            "telephone_number": "740-517-0977"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30652 RED ROCK CT",
            "city": "LOGAN",
            "state": "OH",
            "postal_code": "431389670",
            "telephone_number": "740-385-4006"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GATES",
        "first_name": "NICOLE",
        "middle_name": "LEE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-05-23",
        "last_updated": "2022-05-23",
        "certification_date": "2022-05-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "OH",
            "license": "OPT.007033",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Paula J. Fortner, APRN-CNP
• Megan Fowler, MA CCC-SLP
• Britany Renee Noelle Frasure, PTA
• Justine Lynn Freda Moore, CPHT
• Kelly Ann Gallagan, LCDC-II
• Christian Ernest Gedeon, DC
• Angela Dianne Geil, RN
• Amber D Gillette, QMHS
• Kailynn Goodyear
• Shannon Graham, QMHS, CMS

• Optometrist in Logan, OH
• Providers in Logan, OH by specialty
• Optometrist in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 23, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.