Individual provider Active NPI

Jose Alejandro Gomez, O.D.

  • Optometrist
  • Jackson Heights, NY
National Provider Identifier
1588737977
Registry record updated Mar 30, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
VUT6417 Issued in NY
Practice address
7508 37TH Ave
Jackson Heights, NY 11372-6538
Phone
(718) 476-1458
Fax
(718) 476-1462
NPI assigned
Nov 16, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 30, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X VUT6417 NY Primary

Addresses

Primary practice location

7508 37TH Ave
Jackson Heights, NY 11372-6538

Mailing address

186 Cornwell Ave
Williston Park, NY 11596-1048
Phone (516) 998-0123

Other identifiers 7

IdentifierTypeStateIssuer
A01762OtherNYEYEMED
P4065567OtherNYOXFORD HEALTH
T006417OtherNYMETROPLUS
02266351MedicaidNY
968NOtherNYNATIONAL OPTICAL SERVICES
7184761458OtherNYVSP
3101578OtherNYUNITED HEALTHCARE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
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
I20100128000502 NY Practitioner - Optometry 7012055353 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Other, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

7508 37TH Ave
Jackson Heights, NY 11372-6538
Phone (718) 476-1458

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
VUT6417NYMDOptometrist
006417NYMDAcupuncturist

Practice roles

OrganizationSpecialtyStatusNew patients
Olivos Opticians Inc CurrentSince Jun 1, 2009 Accepting new patients

Locations

7508 37th Ave
Jackson Heights, NY 11372
Phone (718) 476-1458

Organizations & group practices 1

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": "1163635200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1269907200000",
    "number": "1588737977",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "186 CORNWELL AVE",
            "city": "WILLISTON PARK",
            "state": "NY",
            "postal_code": "115961048",
            "telephone_number": "516-998-0123",
            "fax_number": "212-569-3166"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7508 37TH AVE",
            "city": "JACKSON HEIGHTS",
            "state": "NY",
            "postal_code": "113726538",
            "telephone_number": "718-476-1458",
            "fax_number": "718-476-1462"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOMEZ",
        "first_name": "JOSE",
        "middle_name": "ALEJANDRO",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-11-16",
        "last_updated": "2010-03-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NY",
            "license": "VUT6417",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "EYEMED",
            "identifier": "A01762",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OXFORD HEALTH",
            "identifier": "P4065567",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "METROPLUS",
            "identifier": "T006417",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02266351",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NATIONAL OPTICAL SERVICES",
            "identifier": "968N",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "VSP",
            "identifier": "7184761458",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTHCARE",
            "identifier": "3101578",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Jackson Heights, NY

Sources for this page

Verify at the official NPI Registry.