Nicola Granger, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

OPC 5177 Issued in FL

Practice address

524 Canal St
New Smyrna Beach, FL 32168-7012

Phone

(386) 423-5190

NPI assigned

Jul 2, 2015

Last updated

Sep 21, 2021By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Nicola Gough Former name

Medicare fee-for-service enrollment

Enrolled in FL

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

Specialty

Optometry

Education

University Alabama Birmingham - School of Optometry, 2015

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

NSB Eye IncGroup PAC ID 4981135571, 2 clinicians

Total Vision of Port Orange, Inc.Group PAC ID 9830166255, 2 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Networks

• Freedom Health HMO Network

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.

• NSB Eye Inc

  dba NSB Eye

  • Optometrist
  • New Smyrna Beach, FL
  • NPI 1427895234
  Medicare reassignment Care Compare group NPD
• Total Vision of Port Orange, Inc.

  • Optometrist
  • Port Orange, FL
  • NPI 1598984676
  Medicare reassignment Care Compare group NPD
• Myeyedr Optometry of Florida, LLC

  dba MyEyeDr.

  • Optometrist
  • Tallahassee, FL
  • NPI 1073907028
  Medicare reassignment NPD
• Myeyedr Optometry of Florida, LLC

  • Optometrist
  • Clearwater, FL
  • NPI 1730054594
  NPD
• Myeyedr. Optometry of Florida, LLC

  dba MyEyeDr.

  • Optometrist
  • Winter Haven, FL
  • NPI 1760853824
  NPD

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

{
    "created_epoch": "1435795200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1632182400000",
    "number": "1619350022",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1950 OLD GALLOWS RD STE 520",
            "city": "VIENNA",
            "state": "VA",
            "postal_code": "221823970",
            "telephone_number": "703-847-8899",
            "fax_number": "571-223-6780"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "524 CANAL ST",
            "city": "NEW SMYRNA BEACH",
            "state": "FL",
            "postal_code": "321687012",
            "telephone_number": "386-423-5190"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5820 S Williamson Blvd",
            "address_purpose": "LOCATION",
            "city": "Port Orange",
            "state": "FL",
            "postal_code": "321286400",
            "country_code": "US",
            "telephone_number": "386-767-4449",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GRANGER",
        "first_name": "NICOLA",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-07-02",
        "last_updated": "2021-09-21",
        "certification_date": "2021-09-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "FL",
            "license": "OPC 5177",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "IQ6502",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "017822000",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "NICOLA",
            "last_name": "GOUGH",
            "credential": "OD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Stephania Angel Goodknecht, ARNP
• Bruce Gopman II
• Lilly Gors, D.C.
• Andrea Lee Grabowski, APRN
• Mai Linh T Graham, PA-C
• Garrett Maxwell Graves, LMHC
• Karen Lynn Gray, OTR
• Great Strides Rehabilitation Inc.
• Kelly Campbell Grebner, RD
• Kristin Greco

• Optometrist in New Smyrna Beach, FL
• Providers in New Smyrna Beach, FL by specialty
• Optometrist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 21, 2021; 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.
• 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.