NPIMap

Organization Active NPI

Gagnon Vision Medical Group Inc

  • Ophthalmology Physician
  • Livermore, CA
National Provider Identifier
1588091367
Registry record updated Oct 11, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
Legal business name
GAGNON VISION MEDICAL GROUP INC
Practice address
28 Fenton St
Livermore, CA 94550-4144
Phone
(925) 449-4000
NPI assigned
Oct 11, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 11, 2013

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

Authorized official

Name
Mrs. Lori Gagnon, M.A.
Title
Ceo
Phone
(925) 822-8776

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193200000X MULTI-SPECIALTY GROUP 152W00000X
Ophthalmology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207W00000X Primary
Eyewear Supplier 332H00000X

Addresses

Primary practice location

28 Fenton St
Livermore, CA 94550-4144

Mailing address

5575 W Las Positas Blvd
Suite 240
Pleasanton, CA 94588-5801
Phone (925) 460-5000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20140124000219 CA Part B Supplier - Clinic/Group Practice 6103054937 Receives reassigned benefits from 11 practitioners
1 other NPI on this enrollment
Practice locations: Livermore, CA; Pleasanton, CA
O20150305000083 CA DME Supplier - Physician - OphthalmologyDME Supplier - Physician - Optometrist 6103054937 Practice locations: Livermore, CA

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Livermore28 Fenton St, Livermore, CA 94550-4144(925) 449-4000 Prosthetic Lenses: Conventional Eyeglasses|Prosthetic Lenses: Conventional Contact Lenses Accepts assignmentParticipating since Jan 1, 2014

National Provider Directory

National Provider Directory
Tax ID family
Gagnon Vision Medical Group2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 11

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": "1381449600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1381449600000",
    "number": "1588091367",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5575 W LAS POSITAS BLVD",
            "address_2": "SUITE 240",
            "city": "PLEASANTON",
            "state": "CA",
            "postal_code": "945885801",
            "telephone_number": "925-460-5000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "28 FENTON ST",
            "city": "LIVERMORE",
            "state": "CA",
            "postal_code": "945504144",
            "telephone_number": "925-449-4000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GAGNON VISION MEDICAL GROUP INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-10-11",
        "last_updated": "2013-10-11",
        "status": "A",
        "authorized_official_last_name": "GAGNON",
        "authorized_official_first_name": "LORI",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "925-822-8776",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "M.A."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Ophthalmology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "332H00000X",
            "taxonomy_group": "",
            "desc": "Eyewear Supplier",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Livermore, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 11, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.