Gem Optical, LLC

Primary specialty

OptometristTaxonomy code 152W00000X

License

TA1874 Issued in MD

Legal business name

GEM OPTICAL, LLC

Practice address

6603 Riverdale Rd
Riverdale, MD 20737-2908

Phone

(301) 918-0095

Fax

(301) 918-0097

NPI assigned

Oct 3, 2007

Organization subpart

No

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

Authorized official

Name

Gail Ann Petersen, O.D.

Title

Owner

Phone

(301) 918-0095

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1191369600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1307923200000",
    "number": "1437346459",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6603 RIVERDALE RD",
            "city": "RIVERDALE",
            "state": "MD",
            "postal_code": "207372908",
            "telephone_number": "301-918-0095",
            "fax_number": "301-918-0097"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6603 RIVERDALE RD",
            "city": "RIVERDALE",
            "state": "MD",
            "postal_code": "207372908",
            "telephone_number": "301-918-0095",
            "fax_number": "301-918-0097"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GEM OPTICAL, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-03",
        "last_updated": "2011-06-13",
        "status": "A",
        "authorized_official_last_name": "PETERSEN",
        "authorized_official_first_name": "GAIL",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "301-918-0095",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "MD",
            "license": "TA1874",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Optometrist in Riverdale, MD
• Providers in Riverdale, MD by specialty
• Optometrist in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 13, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.