Individual provider Active NPI

Charles I Gold

  • Optometrist
  • New York, NY
National Provider Identifier
1073584330
Registry record updated Feb 4, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
4232 Issued in NY
Practice address
4047 Broadway
New York, NY 10032-1516
Phone
(212) 927-2020
Fax
(212) 923-5576
NPI assigned
Jan 26, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 4, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 4232 NY Primary

Addresses

Primary practice location

4047 Broadway
New York, NY 10032-1516

Mailing address

4047 Broadway
New York, NY 10032-1516
Phone (212) 927-2020

Other identifiers 1

IdentifierTypeStateIssuer
01027696MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
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

Enrollment IDStateProvider typePAC IDDetails
I20100209000410 NY Practitioner - Optometry 6406858075 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Other, 1982
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

4047 Broadway
New York, NY 10032-1516
Phone (212) 927-2020

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
Flagged The directory lists this NPI on an HHS exclusion list. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

State licenses

LicenseStateTypeSpecialty
4232NYMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Glassman Eye LLC PastSince Jan 24, 2010 Accepting new patients
Broadway Vision Center Inc. Optometrist PastSince Jun 21, 2010 Accepting new patients

Organizations & group practices 3

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

NPI Registry JSON

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

{
    "created_epoch": "1138233600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1359936000000",
    "number": "1073584330",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4047 BROADWAY",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100321516",
            "telephone_number": "212-927-2020",
            "fax_number": "212-923-5576"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4047 BROADWAY",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100321516",
            "telephone_number": "212-927-2020",
            "fax_number": "212-923-5576"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOLD",
        "first_name": "CHARLES",
        "middle_name": "I",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-01-26",
        "last_updated": "2013-02-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NY",
            "license": "4232",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01027696",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in New York, NY

Sources for this page

Verify at the official NPI Registry.