Individual provider Active NPI

Jaime Rene Gonzalez, O.D.

  • Optometrist
  • Grand Prairie, TX
National Provider Identifier
1083724322
Registry record updated Feb 29, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
6968T Issued in TX
Practice address
2634 S Carrier Pkwy
101
Grand Prairie, TX 75052-5070
Phone
(972) 641-0011
NPI assigned
Aug 30, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 29, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 6968T TX Primary

Addresses

Primary practice location

2634 S Carrier Pkwy
101
Grand Prairie, TX 75052-5070

Mailing address

2634 S Carrier Pkwy Ste 101
Grand Prairie, TX 75052-5005
Phone (972) 641-0011

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
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
I20071128000312 TX Practitioner - Optometry 1658460738 Practice locations: Plano, TX; Dallas, TX

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
University of Houston - College of Optometry, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

3699 McKinney Ave
Suite 321
Dallas, TX 75204-4563
Phone (214) 219-4402

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
6968TTXMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Thai-an Nguyen OD PLLC Optometrist PastSince Feb 17, 2014 Accepting new patients
20/20 Icare and Iwear, PLLC Optometrist PastSince Mar 8, 2018 Accepting new patients
20-20 Sight, PA Optometrist PastSince Aug 10, 1999 Accepting new patients
Legacy Eye Pieces PC Optometrist PastSince Sep 20, 2022 Accepting new patients
West Village Eye Pieces PC Optometrist PastSince Jul 17, 2022 Accepting new patients
Chris Darilek, OD, PLLC Optometrist PastSince Dec 12, 2021 Accepting new patients
Dr. Michael K. Hammond, PA Optometrist PastSince Jan 13, 2012 Accepting new patients

Organizations & group practices 7

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": "1156896000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1204243200000",
    "number": "1083724322",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2634 S CARRIER PKWY STE 101",
            "city": "GRAND PRAIRIE",
            "state": "TX",
            "postal_code": "750525005",
            "telephone_number": "972-641-0011"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2634 S CARRIER PKWY",
            "address_2": "101",
            "city": "GRAND PRAIRIE",
            "state": "TX",
            "postal_code": "750525070",
            "telephone_number": "972-641-0011"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GONZALEZ",
        "first_name": "JAIME",
        "middle_name": "RENE",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-30",
        "last_updated": "2008-02-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "TX",
            "license": "6968T",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Grand Prairie, TX

Sources for this page

Verify at the official NPI Registry.