Renee Candace Ahlmark-Gordon, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

OPT002136 Issued in GA

Practice address

1569 US Highway 19 S
Leesburg, GA 31763-4939

Phone

(229) 439-1200

Fax

(229) 255-2929

NPI assigned

Sep 23, 2005

Last updated

Mar 29, 2023By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Renee Gordon Former name

Medicare fee-for-service enrollment

Enrolled in GA

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

Specialty

Optometry

Education

Other, 2003

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Myeyedr Optometry of Georgia, LLCGroup PAC ID 8224261201, 100 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: renee.gordon@direct.revolutionehr.com

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.

• Myeyedr Optometry of Georgia, LLC

  dba MyEyeDr.

  • Optometrist
  • Rincon, GA
  • NPI 1437294592
  Medicare reassignment Care Compare group NPD
• Lee County Optical LLC

  • Optometrist
  • Leesburg, GA
  • NPI 1255649273
  Medicare reassignment NPD
• Myeyedr Optometry of Georgia, LLC

  dba MyEyeDr.

  • Optometrist
  • Thomasville, GA
  • NPI 1104210244
  NPD
• Myeyedr Optometry of Georgia, LLC

  dba MyEyeDr.

  • Optometrist
  • Tyrone, GA
  • NPI 1275326571
  NPD
• Berg Eye Center, P. C.

  • Durable Medical Equipment & Medical Supplies
  • Albany, GA
  • NPI 1336261205
  NPD (past)
• Berg Eye Center, PC

  • Ophthalmology Physician
  • Albany, GA
  • NPI 1740276039
  NPD (past)

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

{
    "created_epoch": "1127433600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1680048000000",
    "number": "1376539445",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1569 US HIGHWAY 19 S",
            "city": "LEESBURG",
            "state": "GA",
            "postal_code": "317634939",
            "telephone_number": "229-439-1200",
            "fax_number": "229-255-2929"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1569 US HIGHWAY 19 S",
            "city": "LEESBURG",
            "state": "GA",
            "postal_code": "317634939",
            "telephone_number": "229-439-1200",
            "fax_number": "229-255-2929"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AHLMARK-GORDON",
        "first_name": "RENEE",
        "middle_name": "CANDACE",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-09-23",
        "last_updated": "2023-03-29",
        "certification_date": "2023-03-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "GA",
            "license": "OPT002136",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "RENEE",
            "last_name": "GORDON",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Optometrist in Leesburg, GA
• Providers in Leesburg, GA by specialty
• Optometrist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 29, 2023; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.