Gary Itzenson, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

OE006115T Issued in PA

Practice address

413 Germantown Pike
Ste 200
Lafayette Hill, PA 19444-1816

Phone

(610) 825-8210

Fax

(610) 825-8208

NPI assigned

Jun 17, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in PA, NJ, DE3 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 3

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.

• On Site Health Services PC

  • Optometrist
  • Blue Bell, PA
  • NPI 1720083553

  DE, NJ

  Medicare reassignment NPD Authorized official
• Lafayette Eye Associates, P.C.

  • Specialist
  • Lafayette Hill, PA
  • NPI 1063627925
  Medicare reassignment NPD
• Lafayette Eye Associates, P.C.

  • Optometrist
  • Lafayette Hill, PA
  • NPI 1770579880
  NPD Authorized official
• Hearsay ENT Docs LLC

  • Otolaryngology Physician
  • Media, PA
  • NPI 1962649780
  NPD (past)
• Ophthalmology Consulting Services, PC

  • Ophthalmology Physician
  • Blue Bell, PA
  • NPI 1831195213
  NPD (past)

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

{
    "created_epoch": "1118966400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1770336000000",
    "number": "1508861311",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "413 GERMANTOWN PIKE STE 200",
            "city": "LAFAYETTE HILL",
            "state": "PA",
            "postal_code": "194441816",
            "telephone_number": "610-825-8210",
            "fax_number": "610-825-8208"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "413 GERMANTOWN PIKE",
            "address_2": "STE 200",
            "city": "LAFAYETTE HILL",
            "state": "PA",
            "postal_code": "194441816",
            "telephone_number": "610-825-8210",
            "fax_number": "610-825-8208"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ITZENSON",
        "first_name": "GARY",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-17",
        "last_updated": "2026-02-06",
        "certification_date": "2026-02-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "PA",
            "license": "OE006115T",
            "primary": true
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NJ",
            "license": "27OA00437400",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0009138590001",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2205203",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Joseph Patrick Jordan V

• Optometrist in Lafayette Hill, PA
• Providers in Lafayette Hill, PA by specialty
• Optometrist in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 6, 2026; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.