Active NPI
George H Hagen, O.D.
- Optometrist
- Trinidad, CO
National Provider Identifier
1114019056
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 835
- Practice address
- 1114 E Main St
Trinidad, CO 81082-2034 - Phone
- (719) 846-7342
- Fax
- (719) 846-4041
- NPI assigned
- Sep 29, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 835 | CO | Primary |
| Durable Medical Equipment & Medical Supplies | 332B00000X | |||
| Eyewear Supplier | 332H00000X |
Addresses
Primary practice location
1114 E Main St
Trinidad, CO 81082-2034
Mailing address
1114 E Main St
Trinidad, CO 81082-2034
Phone (719) 846-7342
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 08008351 | Medicaid | CO |
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
| License | State | Type | Specialty |
|---|---|---|---|
| 835 | CO | MD | Optometrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Mt Rose Health Center Palliative Care and Hospice Inc | Past | Accepting new patients | |
| Mt Rose Health Center | Past | Accepting new patients |
Organizations & group practices 2
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.
-
- Legal Medicine
- Trinidad, CO
- NPI 1225474901
-
- Inpatient Hospice
- Trinidad, CO
- NPI 1982052452
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159488000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1210204800000",
"number": "1114019056",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1114 E MAIN ST",
"city": "TRINIDAD",
"state": "CO",
"postal_code": "810822034",
"telephone_number": "719-846-7342",
"fax_number": "719-846-4041"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1114 E MAIN ST",
"city": "TRINIDAD",
"state": "CO",
"postal_code": "810822034",
"telephone_number": "719-846-7342",
"fax_number": "719-846-4041"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HAGEN",
"first_name": "GEORGE",
"middle_name": "H",
"name_prefix": "Dr.",
"credential": "O.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-09-29",
"last_updated": "2008-05-08",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "CO",
"license": "835",
"primary": true
},
{
"code": "332B00000X",
"taxonomy_group": "",
"desc": "Durable Medical Equipment & Medical Supplies",
"state": null,
"license": null,
"primary": false
},
{
"code": "332H00000X",
"taxonomy_group": "",
"desc": "Eyewear Supplier",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "08008351",
"state": "CO"
}
],
"endpoints": [],
"other_names": []
}Other providers in Trinidad, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 8, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.