Kelly Bourgon, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

3557 Issued in CO

Practice address

412 Main St
Longmont, CO 80501-5535

Phone

(303) 651-6700

NPI assigned

Apr 28, 2018

Last updated

Jan 30, 2023By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in CO

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

Specialty

Optometry

Education

Pacific University - College of Optometry, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Eye Care Associates of Co LLCGroup PAC ID 9537597828, 63 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Eye Care Associates of Co LLC

  dba Optical Matters

  • Optometrist
  • Centennial, CO
  • NPI 1124674049
  Medicare reassignment Care Compare group NPD
• Abba Eye Care PC

  • Optometrist
  • Colorado Springs, CO
  • NPI 1952301129
  Medicare reassignment NPD
• One Hour Optical Medical Services, PC

  dba One Hour Optical

  • Optometrist
  • Denver, CO
  • NPI 1770648297
  Medicare reassignment
• Abba Eye Care PC

  • Optometrist
  • Colorado Springs, CO
  • NPI 1992919419
  NPD
• Eye Care Associates of Co LLC

  dba Creston Vision Clinic

  • Optometrist
  • Creston, IA
  • NPI 1548023518
  NPD

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

{
    "created_epoch": "1524873600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1675036800000",
    "number": "1194213751",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1768 S TAFT AVE APT 103",
            "city": "LOVELAND",
            "state": "CO",
            "postal_code": "805377291",
            "telephone_number": "207-356-5387"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "412 MAIN ST",
            "city": "LONGMONT",
            "state": "CO",
            "postal_code": "805015535",
            "telephone_number": "303-651-6700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOURGON",
        "first_name": "KELLY",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-04-28",
        "last_updated": "2023-01-30",
        "certification_date": "2023-01-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NY",
            "license": "TUV008844",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CO",
            "license": "3557",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Boulder Valley Gastroenterology Inc. (Gastroenterology of the Rockies)
• Boulder Valley Thoracic and Cardiovascular Surgery
• Boulder Valley Women's Health Center, Inc. (Women's Health at Longmont)
• Stephanie Jane Boulton, MA, LPC
• Ashley Bourgois
• Shyll Bowen, BCBA
• Kyle M Box
• Michael Brace, PHARMD
• Marcy Jo Brack, RN
• Cara P Bradley, M.A. CONFLICTMANAGEM

• Optometrist in Longmont, CO
• Providers in Longmont, CO by specialty
• Optometrist in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 30, 2023; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.