Active NPI
Guy Thomas McDougal, O.D.
- Optometrist
- Mesa, AZ
National Provider Identifier
1154374684
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 691
- Practice address
- 1121 S Gilbert Rd
Suite 103
Mesa, AZ 85204-5235 - Phone
- (480) 854-3310
- Fax
- (480) 854-1157
- NPI assigned
- May 18, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 691 | AZ | Primary |
Addresses
Primary practice location
1121 S Gilbert Rd
Suite 103
Mesa, AZ 85204-5235
Mailing address
3228 E Fountain St
Mesa, AZ 85213-5527
Phone (480) 854-3310
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 |
|---|---|---|---|
| 691 | AZ | MD | Optometrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| San Tan Village Eye Care LLC | Optometrist | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Optometrist
- Gilbert, AZ
- NPI 1760678320
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1147910400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1318550400000",
"number": "1154374684",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3228 E FOUNTAIN ST",
"city": "MESA",
"state": "AZ",
"postal_code": "852135527",
"telephone_number": "480-854-3310",
"fax_number": "480-854-1157"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1121 S GILBERT RD",
"address_2": "SUITE 103",
"city": "MESA",
"state": "AZ",
"postal_code": "852045235",
"telephone_number": "480-854-3310",
"fax_number": "480-854-1157"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MCDOUGAL",
"first_name": "GUY",
"middle_name": "THOMAS",
"name_prefix": "Dr.",
"credential": "O.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-05-18",
"last_updated": "2011-10-14",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "AZ",
"license": "691",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mesa, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 14, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.