Active NPI
Dennis Lee Gaedig, O.D.
- Optometrist
- Ontario, CA
National Provider Identifier
1336281112
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 6661T
- Practice address
- 1 Mills Cir
1016
Ontario, CA 91764-5207 - Phone
- (909) 481-1083
- Fax
- (909) 484-2060
- NPI assigned
- Feb 12, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 6661T | CA | Primary |
Addresses
Primary practice location
1 Mills Cir
1016
Ontario, CA 91764-5207
Mailing address
15589 Ficus St
Chino Hills, CA 91709-4251
Phone (909) 597-4136
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6661T | CA | MD | Optometrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Sterling Optical#541 | Optometrist | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Optometrist
- Ontario, CA
- NPI 1003008160
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1171238400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1336281112",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "15589 FICUS ST",
"city": "CHINO HILLS",
"state": "CA",
"postal_code": "917094251",
"telephone_number": "909-597-4136",
"fax_number": "909-484-2060"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1 MILLS CIR",
"address_2": "1016",
"city": "ONTARIO",
"state": "CA",
"postal_code": "917645207",
"telephone_number": "909-481-1083",
"fax_number": "909-484-2060"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GAEDIG",
"first_name": "DENNIS",
"middle_name": "LEE",
"name_prefix": "Dr.",
"credential": "O.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-02-12",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "CA",
"license": "6661T",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Ontario, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.