PG Optical LLC

Primary specialty

OptometristTaxonomy code 152W00000X

Legal business name

PG OPTICAL LLC

Practice address

306 N Bishop Ave Ste B
Rolla, MO 65401-2953

Phone

(573) 426-6779

NPI assigned

Mar 9, 2023

Last updated

Nov 20, 2023By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Kevin Gardner, OD

Title

Owner

Phone

(573) 426-6779

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MO

Enrollment records 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Michele Leigh Haley, O.D.

  • Optometrist
  • Jefferson City, MO
  • NPI 1144333675
  Medicare reassignment NPD
• Knial Richard Piper, O.D.

  • Optometrist
  • West Plains, MO
  • NPI 1083649313
  NPD

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

{
    "created_epoch": "1678320000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1700438400000",
    "number": "1447950183",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "306 N BISHOP AVE STE B",
            "city": "ROLLA",
            "state": "MO",
            "postal_code": "654012953",
            "telephone_number": "573-426-6779"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "306 N BISHOP AVE STE B",
            "city": "ROLLA",
            "state": "MO",
            "postal_code": "654012953",
            "telephone_number": "573-426-6779"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PG OPTICAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-03-09",
        "last_updated": "2023-11-20",
        "certification_date": "2023-11-20",
        "status": "A",
        "authorized_official_last_name": "GARDNER",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "573-426-6779",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jenny L Pennycook, M.D.
• Gregory Pernoud, DDS
• Peterson Family Chiropractic and Wellness Center
• Diane M Peterson, DC
• Keith A Peterson, DC
• Phelps County Clerk (Phelps County Health Department)
• Phelps County Industrial Solutions Inc
• Phelps County Regional Medical Center
• Phelps County Regional Medical Center (Phelps Health)
• Phelps County Regional Medical Center (Phelps Health Medical Group)

• Optometrist in Rolla, MO
• Providers in Rolla, MO by specialty
• Optometrist in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 20, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.