Individual provider Active NPI

Michael Alexander Gomez, O.D.

  • Optometrist
  • Hialeah, FL
National Provider Identifier
1477606366
Registry record updated Mar 20, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
OPC 3891 Issued in FL
Practice address
1770 W 32ND PL
Hialeah, FL 33012-4512
Phone
(305) 885-4477
NPI assigned
Jan 22, 2007
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 20, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X OPC 3891 FL Primary

Addresses

Primary practice location

1770 W 32ND PL
Hialeah, FL 33012-4512

Mailing address

1447 NW 156TH Ave
Pembroke Pines, FL 33028-1665
Phone (954) 430-9564

Other identifiers 1

IdentifierTypeStateIssuer
101685200MedicaidFL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
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

Enrollment IDStateProvider typePAC IDDetails
I20110107000495 FL Practitioner - Optometry 3375732282 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
OPC 3891FLMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
DRS. Cukierman & Gomez, Inc Optometrist CurrentSince Dec 20, 2023 Accepting new patients
Advanced Vision Care Inc Optometrist CurrentSince Jul 1, 2019 Accepting new patients

Locations

2873 Stirling Rd
Ft Lauderdale, FL 33312
Phone (954) 983-4969

246 S Flamingo Rd
Pembroke Pines, FL 33027
Phone (954) 442-4602

Networks

  • Freedom Health HMO Network

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1169424000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1584662400000",
    "number": "1477606366",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1447 NW 156TH AVE",
            "city": "PEMBROKE PINES",
            "state": "FL",
            "postal_code": "330281665",
            "telephone_number": "954-430-9564"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1770 W 32ND PL",
            "city": "HIALEAH",
            "state": "FL",
            "postal_code": "330124512",
            "telephone_number": "305-885-4477"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOMEZ",
        "first_name": "MICHAEL",
        "middle_name": "ALEXANDER",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-01-22",
        "last_updated": "2020-03-20",
        "certification_date": "2020-03-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "FL",
            "license": "OPC 3891",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "101685200",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Hialeah, FL

Sources for this page

Verify at the official NPI Registry.