Jimmy S Gandy, O.D.
Individual provider Active NPI Optometrist · Rayville, LA
NPI 1366447310 · NPPES record last updated Nov 27, 2018
Key facts
- NPI
- 1366447310
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Optometrist 152W00000X
- License
- 1114-186AT (LA)
- Practice address
- 107 Maxwell Dr
Rayville, LA 71269-5558 - Phone
- (318) 728-2299
- Fax
- (318) 728-0081
- NPI assigned
- Jun 16, 2005
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 4
Medicare Care Compare profile
- 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 Professional
Practice addresses (Care Compare)
107 Maxwell Dr
Rayville, LA 71269-5558
Phone (318) 728-2299
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Cataract surgery | 50 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in LA
- 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 |
|---|---|---|---|---|
| I20101209000036 | LA | Practitioner - Optometry | 2264528306 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1115 | LA | MD | Speech-Language Pathologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Gandy Eye Care a Professional | Optometrist | Current |
Accepting new patients |
| Dr Elvis Surles a Professional Optometry Corporation | Optometrist | Past | Accepting new patients |
| Moss Eye Care, LLC | Optometrist | Past | Accepting new patients |
| W E Marionneaux Jr OD LLC | Optometrist | Past |
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
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 1114-186AT | LA | Yes |
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
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1936251 | Medicaid | LA |
Other providers in Rayville, LA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 27, 2018. 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.