Gregory G Montavon, O.D

Primary specialty

OptometristTaxonomy code 152W00000X

License

35556/T794 Issued in OH

Practice address

414 W Emmitt Ave
Waverly, OH 45690-1008

Phone

(740) 947-8191

Fax

(740) 947-5554

NPI assigned

Apr 6, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in OH

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

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1144281600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1409702400000",
    "number": "1154383883",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "414 W EMMITT AVE",
            "city": "WAVERLY",
            "state": "OH",
            "postal_code": "456901008",
            "telephone_number": "740-947-8191",
            "fax_number": "740-947-5554"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "414 W EMMITT AVE",
            "city": "WAVERLY",
            "state": "OH",
            "postal_code": "456901008",
            "telephone_number": "740-947-8191",
            "fax_number": "740-947-5554"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MONTAVON",
        "first_name": "GREGORY",
        "middle_name": "G",
        "name_prefix": "Dr.",
        "credential": "O.D",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-06",
        "last_updated": "2014-09-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "OH",
            "license": "35556/T794",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Anthony Michael Mogan, CDCA,QMHS
• Dusty Mogan
• Brianna Mollett
• Sherri Mollett, CDCA
• Tiffani Danielle Mollett, CDCA
• April Dawn Montgomery, LPN
• Jennifer Sue Montgomery, CT
• Courtney Elaine Moore, NP
• Jenna Moore
• Jerri Dawn Moore

• Optometrist in Waverly, OH
• Providers in Waverly, OH by specialty
• Optometrist in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 3, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.