Renee Candace Ahlmark-Gordon, OD
Individual provider Active NPI Optometrist · Leesburg, GA
NPI 1376539445 · NPPES record last updated Mar 29, 2023
Key facts
- NPI
- 1376539445
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Optometrist 152W00000X
- License
- OPT002136 (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
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 12
Medicare Care Compare profile
- Specialty
- Optometry
- Education
- Other, 2003
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Myeyedr Optometry of Georgia, LLC
Practice addresses (Care Compare)
15196 US Hwy 19 S
Thomasville, GA 31757-4820
Phone (229) 228-4770
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in GA
- 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 |
|---|---|---|---|---|
| I20040212000368 | GA | Practitioner - Optometry | 0648164327 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Myeyedr Optometry of Georgia, LLC | Optometrist | Current | Accepting new patients |
| Myeyedr Optometry of Georgia, LLC | Optometrist | Current |
Accepting new patients |
| Lee County Optical LLC | Optometrist | Current |
Accepting new patients |
| Myeyedr Optometry of Georgia, LLC | Optometrist | Current |
Accepting new patients |
| Berg Eye Center, P. C. | Past | Accepting new patients | |
| Berg Eye Center, PC | Past | Accepting new patients |
Locations
2610 Dawson Rd
Albany, GA 31707
Phone (229) 435-6776
4875 Altama Ave
Brunswick, GA 31520
Phone (912) 554-0010
1569 US Highway 19 S
Leesburg, GA 31763
Phone (229) 439-1200
15196 US Highway 19 S
Thomasville, GA 31757
Phone (229) 228-4770
8614 Westwood Center Dr
Fl 9
Vienna, VA 22182
Interoperability endpoints
- renee.gordon@direct.revolutionehr.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | OPT002136 | GA | Yes |
Addresses
Primary practice location
1569 US Highway 19 S
Leesburg, GA 31763-4939
Mailing address
1569 US Highway 19 S
Leesburg, GA 31763-4939
Phone (229) 439-1200
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 003105037A | Medicaid | GA |
Other names
- Renee Gordon
Other providers in Leesburg, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 29, 2023. 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.