Kelly Bourgon, OD
Individual provider Active NPI Optometrist · Longmont, CO
NPI 1194213751 · NPPES record last updated Jan 30, 2023
Key facts
- NPI
- 1194213751
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Optometrist 152W00000X
- License
- 3557 (CO)
- Practice address
- 412 Main St
Longmont, CO 80501-5535 - Phone
- (303) 651-6700
- NPI assigned
- Apr 28, 2018
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 10
Medicare Care Compare profile
- 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 LLC
Practice addresses (Care Compare)
412 Main St
Longmont, CO 80501-5535
Phone (303) 651-6700
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Cataract surgery | 13 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CO
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20200917003222 | CO | Practitioner - Optometry | 4981955895 | Reassigns benefits to 3 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3557 | CO | MD | Counselor |
| TUV008844 | NY | MD | Optometrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Abba Eye Care PC | Optometrist | Current |
Accepting new patients |
| Abba Eye Care PC | Optometrist | Current |
Accepting new patients |
| Eye Care Associates of Co LLC | Optometrist | Current |
Accepting new patients |
| Eye Care Associates of Co LLC | Optometrist | Current |
Accepting new patients |
Locations
1130 Lake Plaza Dr
Ste 130
Colorado Springs, CO 80906
Phone (719) 578-2020
1685 S Colorado Blvd
Unit O
Denver, CO 80222
Phone (303) 757-6747
8925 Ridgeline Blvd
Ste 107
Highlands Ranch, CO 80129
Phone (303) 791-2727
412 Main St
Longmont, CO 80501
Phone (303) 651-6700
412 Main St
Unit 1
Longmont, CO 80501
900 W Northern Ave
Pueblo, CO 81004
Phone (719) 542-2222
1650 W US Highway 50
Pueblo, CO 81008
Phone (719) 542-1222
111 E 4th St
Ste 440
Alton, IL 62002
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | TUV008844 | NY | |
| Optometrist | 152W00000X | 3557 | CO | Yes |
Addresses
Primary practice location
412 Main St
Longmont, CO 80501-5535
Mailing address
1768 S Taft Ave Apt 103
Loveland, CO 80537-7291
Phone (207) 356-5387
Other providers in Longmont, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 30, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.