Gregory Brent Hagedorn, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

1016DT Issued in KY

Practice address

1413 N Elm St
Suite 102
Henderson, KY 42420-2768

Phone

(270) 826-1500

Fax

(270) 827-0757

NPI assigned

May 2, 2006

Last updated

Jul 22, 2014By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in KY

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

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Crystal Stone Oliver, O.D.

  • Optometrist
  • Henderson, KY
  • NPI 1437535648
  Medicare reassignment

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.

• Crystal S Oliver OD PLLC

  • Optometrist
  • Henderson, KY
  • NPI 1760990568
  Medicare reassignment NPD
• Dr. Gregory B. Hagedorn, OD

  dba Gregory B Hagedorn

  • Optometrist
  • Henderson, KY
  • NPI 1912271255
  Authorized official Same address or phone

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

{
    "created_epoch": "1146528000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1405987200000",
    "number": "1316905169",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 577",
            "city": "HENDERSON",
            "state": "KY",
            "postal_code": "424190577",
            "telephone_number": "270-826-1500",
            "fax_number": "270-827-0757"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1413 N ELM ST",
            "address_2": "SUITE 102",
            "city": "HENDERSON",
            "state": "KY",
            "postal_code": "424202768",
            "telephone_number": "270-826-1500",
            "fax_number": "270-827-0757"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HAGEDORN",
        "first_name": "GREGORY",
        "middle_name": "BRENT",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-05-02",
        "last_updated": "2014-07-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "KY",
            "license": "1016DT",
            "primary": true
        },
        {
            "code": "152WC0802X",
            "taxonomy_group": "",
            "desc": "Optometrist, Corneal and Contact Management",
            "state": "KY",
            "license": "1016DT",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "77010163",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Justin Matthew Greubel, PHARMD
• Dawson Gross
• Derek Lee Groves, RN
• Amanda Gunn, FNP
• Kerry Conrad Gusler, DO
• Michael R Hagerman, CRNA
• James Allan Hagman, M.ED., LCADC
• Taylor Hall, LAT, ATC
• Yvonne Hall, CSW
• Ashley Nicole Hamilton, LMHC

• Optometrist in Henderson, KY
• Providers in Henderson, KY by specialty
• Optometrist in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 22, 2014; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.