Individual provider Active NPI

Nicole Bergamo, O.D.

  • Optometrist
  • Colorado Springs, CO
National Provider Identifier
1306906771
Registry record updated Dec 20, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
2166 Issued in CO
Practice address
11550 Ridgeline Dr Unit 106
Colorado Springs, CO 80921-3953
Phone
(719) 636-2020
Fax
(719) 354-4071
NPI assigned
Dec 8, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 20, 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 2166 CO Primary

Addresses

Primary practice location

11550 Ridgeline Dr Unit 106
Colorado Springs, CO 80921-3953

Mailing address

11550 Ridgeline Dr Unit 106
Colorado Springs, CO 80921-3953
Phone (719) 636-2020

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20070327000695 CO Practitioner - Optometry 6103846415 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Southern College of Optometry, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

11550 Ridgeline Dr
Unit 106
Colorado Springs, CO 80921-3953
Phone (719) 636-2020

Procedures performed for Medicare patients

ProcedureNumber of procedures
Cataract surgery1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2166COMDCounseling Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Bergamo P.C. Dba Bergamo Vision Optometrist CurrentSince Feb 20, 2018 Accepting new patients
Chapel Hills Vision P C Optometrist PastSince Apr 28, 2024 Accepting new patients
Chapel Hills Vision P C Optometrist Past Accepting new patients
Oneopto Co 1 PLLC Optometrist PastSince Apr 20, 2010 Accepting new patients
Rockrimmon Vision Clinic Optometrist PastSince Feb 1, 2000 Accepting new patients

Locations

11550 Ridgeline Dr
Unit 106
Colorado Springs, CO 80921
Phone (719) 636-2020

Organizations & group practices 5

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": "1165536000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1734652800000",
    "number": "1306906771",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11550 RIDGELINE DR UNIT 106",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809213953",
            "telephone_number": "719-636-2020",
            "fax_number": "719-354-4071"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11550 RIDGELINE DR UNIT 106",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809213953",
            "telephone_number": "719-636-2020",
            "fax_number": "719-354-4071"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BERGAMO",
        "first_name": "NICOLE",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-12-08",
        "last_updated": "2024-12-20",
        "certification_date": "2024-12-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CO",
            "license": "2166",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Colorado Springs, CO

Sources for this page

Verify at the official NPI Registry.