NPIMap

Organization Active NPI

Gordon R. Boyd O.D.,P.C.

  • Durable Medical Equipment & Medical Supplies
  • Crawfordsville, IN
National Provider Identifier
1568650331
Registry record updated Apr 1, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X
License
0474130001 Issued in IN
Legal business name
GORDON R. BOYD O.D.,P.C.
Practice address
1485 S. Grant Ave
Suite a
Crawfordsville, IN 47933-3329
Phone
(765) 362-3209
Fax
(765) 364-9233
NPI assigned
Oct 5, 2007
Last updated
Apr 1, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 1, 2008

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

Authorized official

Name
Dr. Gordon R. Boyd, O.D.NPI 1427052216
Title
President/Optometrist
Phone
(765) 362-3209

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
Durable Medical Equipment & Medical Supplies 332B00000X 0474130001 IN Primary

Addresses

Primary practice location

1485 S. Grant Ave
Suite a
Crawfordsville, IN 47933-3329

Mailing address

1485 S. Grant Ave
Suite a
Crawfordsville, IN 47933-3329
Phone (765) 362-3209

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20071008000241 IN Part B Supplier - Clinic/Group Practice 5092800979 Receives reassigned benefits from 1 practitioner
Practice locations: Crawfordsville, IN

National Provider Directory

National Provider Directory

Locations

1485 S Grant Ave
Ste A
Crawfordsvlle, IN 47933
Phone (317) 362-3209

Practitioners & affiliated clinicians

Practitioners 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1191542400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1207008000000",
    "number": "1568650331",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1485 S. GRANT AVE",
            "address_2": "SUITE A",
            "city": "CRAWFORDSVILLE",
            "state": "IN",
            "postal_code": "479333329",
            "telephone_number": "765-362-3209",
            "fax_number": "765-364-9233"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1485 S. GRANT AVE",
            "address_2": "SUITE A",
            "city": "CRAWFORDSVILLE",
            "state": "IN",
            "postal_code": "479333329",
            "telephone_number": "765-362-3209",
            "fax_number": "765-364-9233"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GORDON R. BOYD O.D.,P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-05",
        "last_updated": "2008-04-01",
        "status": "A",
        "authorized_official_last_name": "BOYD",
        "authorized_official_first_name": "GORDON",
        "authorized_official_middle_name": "R.",
        "authorized_official_title_or_position": "PRESIDENT/OPTOMETRIST",
        "authorized_official_telephone_number": "765-362-3209",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "IN",
            "license": "0474130001",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Crawfordsville, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 1, 2008; 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.