NPIMap

Organization Active NPI

Michael W Gaydos, OD PC

  • Optometrist
  • Owasso, OK
National Provider Identifier
1497168587
Registry record updated Jan 12, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
2137 Issued in OK
Legal business name
MICHAEL W GAYDOS, OD PC
Practice address
8430 N 123Rd East Ave
Owasso, OK 74055-2130
Phone
(918) 272-5755
Fax
(918) 272-0330
NPI assigned
Jun 5, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 12, 2015

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

Authorized official

Name
Dr. Michael William Gaydos, ODNPI 1225301443
Title
Owner/Physician
Phone
(918) 510-6432

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X 2137 OK Primary

Addresses

Primary practice location

8430 N 123Rd East Ave
Owasso, OK 74055-2130

Mailing address

8430 N 123Rd East Ave
Owasso, OK 74055-2130
Phone (918) 272-5755

Other names 1

  • Vision Source Owasso Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20141222001862 OK Part B Supplier - Clinic/Group Practice 2567785686 Receives reassigned benefits from 4 practitioners
Practice locations: Owasso, OK

National Provider Directory

National Provider Directory

Locations

10304 N Garnett Rd
Owasso, OK 74055
Phone (918) 272-5755

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1401926400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1421020800000",
    "number": "1497168587",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8430 N 123RD EAST AVE",
            "city": "OWASSO",
            "state": "OK",
            "postal_code": "740552130",
            "telephone_number": "918-272-5755",
            "fax_number": "918-272-0330"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8430 N 123RD EAST AVE",
            "city": "OWASSO",
            "state": "OK",
            "postal_code": "740552130",
            "telephone_number": "918-272-5755",
            "fax_number": "918-272-0330"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MICHAEL W GAYDOS, OD PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-06-05",
        "last_updated": "2015-01-12",
        "status": "A",
        "authorized_official_last_name": "GAYDOS",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "WILLIAM",
        "authorized_official_title_or_position": "OWNER/PHYSICIAN",
        "authorized_official_telephone_number": "918-510-6432",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "OK",
            "license": "2137",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Vision Source Owasso",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Owasso, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 12, 2015; 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.