Individual provider Active NPI

Stacy G Gandy, O.D.

  • Optometrist
  • Rayville, LA
National Provider Identifier
1205831252
Registry record updated Jan 6, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
1114-186T Issued in LA
Practice address
107 Maxwell Dr
Rayville, LA 71269-5558
Phone
(318) 728-2299
Fax
(318) 728-0081
NPI assigned
Jun 16, 2005
Last updated
Jan 6, 2011By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 6, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 1114-186T LA Primary

Addresses

Primary practice location

107 Maxwell Dr
Rayville, LA 71269-5558

Mailing address

2651 Highway 15
Mangham, LA 71259-5166
Phone (318) 248-3321

Other identifiers 1

IdentifierTypeStateIssuer
1959171MedicaidLA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in LA
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
I20101012000636 LA Practitioner - Optometry 0446346589 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Southern College of Optometry, 1992
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Gandy Eye Care a ProfessionalGroup PAC ID 7719073857, 3 clinicians

Practice addresses (Care Compare)

107 Maxwell Dr
Rayville, LA 71269-5558
Phone (318) 728-2299

Procedures performed for Medicare patients

ProcedureNumber of procedures
Cataract surgery14

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
1114-186ATLAMDOptometrist
1114LAMDHearing Instrument Specialist

Practice roles

OrganizationSpecialtyStatusNew patients
Gandy Eye Care a Professional Optometrist CurrentSince Mar 1, 1994 Accepting new patients
W E Marionneaux Jr OD LLC Optometrist PastSince Jun 1, 2004 Accepting new patients

Locations

404 S Washington St
Bastrop, LA 71220
Phone (318) 281-6682

107 Maxwell Dr
Rayville, LA 71269
Phone (318) 728-2277

6609 Main St
Winnsboro, LA 71295
Phone (318) 435-5145

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1118880000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1294272000000",
    "number": "1205831252",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2651 HIGHWAY 15",
            "city": "MANGHAM",
            "state": "LA",
            "postal_code": "712595166",
            "telephone_number": "318-248-3321",
            "fax_number": "318-728-0081"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "107 MAXWELL DR",
            "city": "RAYVILLE",
            "state": "LA",
            "postal_code": "712695558",
            "telephone_number": "318-728-2299",
            "fax_number": "318-728-0081"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GANDY",
        "first_name": "STACY",
        "middle_name": "G",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-06-16",
        "last_updated": "2011-01-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "LA",
            "license": "1114-186T",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1959171",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Rayville, LA

Sources for this page

Verify at the official NPI Registry.