Jeremiah Gagnon, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

ODO-100614 Issued in ID

Practice address

710 W Superior St Ste B
Sandpoint, ID 83864-1684

Phone

(208) 263-9000

NPI assigned

May 30, 2023

Last updated

Jun 12, 2023By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in ID

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, 2023

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Eye Care for YouGroup PAC ID 5395765853, 5 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Eye Care for You

  • Optometrist
  • Sandpoint, ID
  • NPI 1710042353
  Medicare reassignment Care Compare group NPD
• America's Best Contacts & Eyeglasses

  • Optician
  • Coeur d'Alene, ID
  • NPI 1508197336
  NPD (past)

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

{
    "created_epoch": "1685404800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1686528000000",
    "number": "1407549207",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "710 W SUPERIOR ST STE B",
            "city": "SANDPOINT",
            "state": "ID",
            "postal_code": "838641684",
            "telephone_number": "208-946-7187"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "710 W SUPERIOR ST STE B",
            "city": "SANDPOINT",
            "state": "ID",
            "postal_code": "838641684",
            "telephone_number": "208-263-9000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3500 N Government Way Ste 102",
            "address_purpose": "LOCATION",
            "city": "Coeur D Alene",
            "state": "ID",
            "postal_code": "838155281",
            "country_code": "US",
            "telephone_number": "208-667-6545",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GAGNON",
        "first_name": "JEREMIAH",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-05-30",
        "last_updated": "2023-06-12",
        "certification_date": "2023-06-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "ID",
            "license": "ODO-100614",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Linda D Fucone, LCSW
• Kelly A. Fuhrman, ARNP FNP-BC
• Alicia Ann Gabica-Grand, LMSW
• Audra Lou Gabica
• Maia Cassandra Gaddess, LMT
• Julie Beth Gagnon, OD
• Kaitlin Rebecca Gagnon, DMD
• Gina Marie Garvin, LMT
• Joline Elizabeth Genay-Wolf, LMT
• Megan Gentry, PA-C

• Optometrist in Sandpoint, ID
• Providers in Sandpoint, ID by specialty
• Optometrist in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 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.