Individual provider Active NPI

Sidney Aldrian Reynes Magdaong, OD

  • Optometrist
  • Bloomington, IN
National Provider Identifier
1174364178
Registry record updated Jun 24, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
18004493A Issued in IN
Practice address
744 E 3Rd St
Bloomington, IN 47405-3603
Phone
(812) 855-8436
NPI assigned
Jun 4, 2024
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 24, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 18004493A IN Primary

Addresses

Primary practice location

744 E 3Rd St
Bloomington, IN 47405-3603

Mailing address

PO Box 7062
Indianapolis, IN 46207-7062
Phone (812) 855-8436

Other names 1

  • Dr. Sidney Magdaong Professional name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN
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
I20240612001236 IN Practitioner - Optometry 8527500099 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Indiana University - School of Optometry, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Precision Eye Group PCGroup PAC ID 0042479610, 9 clinicians

Practice addresses (Care Compare)

4619 W Richland Plaza Dr
Bloomington, IN 47404-9776
Phone (812) 332-3937

Procedures performed for Medicare patients

ProcedureNumber of procedures
Cataract surgery14

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
18004493AINMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Dr Kristina Morris LLC Optometrist CurrentSince Mar 1, 2025 Accepting new patients
Precision Eye Group P.C. Optometrist CurrentSince Mar 1, 2025 Accepting new patients
Indiana University Optometrist PastSince Jun 30, 2024 Accepting new patients

Locations

4619 W Richland Plaza Dr
Bloomington, IN 47404
Phone (812) 332-3937

322 S Woodscrest Dr
Bloomington, IN 47401
Phone (812) 332-2020

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1717459200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1719187200000",
    "number": "1174364178",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 7062",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462077062",
            "telephone_number": "812-855-8436"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "744 E 3RD ST",
            "city": "BLOOMINGTON",
            "state": "IN",
            "postal_code": "474053603",
            "telephone_number": "812-855-8436"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAGDAONG",
        "first_name": "SIDNEY ALDRIAN",
        "middle_name": "REYNES",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2024-06-04",
        "last_updated": "2024-06-24",
        "certification_date": "2024-06-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "IN",
            "license": "18004493A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SIDNEY",
            "last_name": "MAGDAONG",
            "prefix": "DR.",
            "credential": "OD",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

Other providers in Bloomington, IN

Sources for this page

Verify at the official NPI Registry.