NPIMap

Individual provider Active NPI

John A Gazaway, OD

  • Optometrist
  • Laurie, MO
National Provider Identifier
1114011913
Registry record updated Sep 1, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
2009002132 Issued in MO
Practice address
138 S. Main
Suite C
Laurie, MO 65038
Phone
(573) 374-5222
Fax
(573) 374-7351
NPI assigned
Oct 3, 2006
Last updated
Sep 1, 2010By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 1, 2010

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 1520T IA
Optometrist 152W00000X 2009002132 MO Primary

Addresses

Primary practice location

138 S. Main
Suite C
Laurie, MO 65038

Mailing address

P.O. Box 1185
Laurie, MO 65038
Phone (573) 374-5222

Other identifiers 2

IdentifierTypeStateIssuer
05707OtherIABLUE SHIELD
0057075MedicaidIA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
1520TIAMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
B &B Eyecare, LLC Optometrist Past Accepting new patients
Broadway Vision Source, Incorporated Optometrist Past Accepting new patients
Lake Family Vision Center Inc Optometrist Past 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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1159833600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1283299200000",
    "number": "1114011913",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P.O. BOX 1185",
            "city": "LAURIE",
            "state": "MO",
            "postal_code": "65038",
            "telephone_number": "573-374-5222",
            "fax_number": "573-374-7351"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "138 S. MAIN",
            "address_2": "SUITE C",
            "city": "LAURIE",
            "state": "MO",
            "postal_code": "65038",
            "telephone_number": "573-374-5222",
            "fax_number": "573-374-7351"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GAZAWAY",
        "first_name": "JOHN",
        "middle_name": "A",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-03",
        "last_updated": "2010-09-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "IA",
            "license": "1520T",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MO",
            "license": "2009002132",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "05707",
            "state": "IA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0057075",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Laurie, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 1, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.