Gordon W. Jennings OD PC

Primary specialty

OptometristTaxonomy code 152W00000X

License

0618000167 Issued in VA

Legal business name

GORDON W. JENNINGS OD PC

Practice address

310 E Main St
Wytheville, VA 24382-2326

Phone

(276) 228-2771

Fax

(276) 228-9097

NPI assigned

Dec 18, 2006

Organization subpart

No

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

Authorized official

Name

Billie L Taylor, ABO, NCLC, CPOT

Title

Office Manager

Phone

(276) 228-2771

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in VA

Enrollment records 1

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Gordon W Jennings, OD PC

  • Optometrist
  • Wytheville, VA
  • NPI 1669435533
  Medicare reassignment NPD
• Amber Hurley McCulley, OD

  • Optometrist
  • Tazewell, VA
  • NPI 1881956142
  Medicare reassignment NPD
• Abigail Joy Mitchell, OD

  • Optometrist
  • Tazewell, VA
  • NPI 1831882521
  Medicare reassignment NPD

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

{
    "created_epoch": "1166400000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1213920000000",
    "number": "1669535050",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "310 E MAIN ST",
            "city": "WYTHEVILLE",
            "state": "VA",
            "postal_code": "243822326",
            "telephone_number": "276-228-2771",
            "fax_number": "276-228-9097"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "310 E MAIN ST",
            "city": "WYTHEVILLE",
            "state": "VA",
            "postal_code": "243822326",
            "telephone_number": "276-228-2771",
            "fax_number": "276-228-9097"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GORDON W. JENNINGS OD PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-18",
        "last_updated": "2008-06-20",
        "status": "A",
        "authorized_official_last_name": "TAYLOR",
        "authorized_official_first_name": "BILLIE",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "276-228-2771",
        "authorized_official_credential": "ABO, NCLC, CPOT"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": "VA",
            "license": "0618000167",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE # DR. GRAU (SECOND DOCTOR IN PRACTICE)",
            "identifier": "410001097",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "009234268",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "079556",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Michael Bert Gaultney, RPH
• Rebecca Lynn Gibson-Dye, SPEECH LANGUAGE PATH
• Tina Gilbert
• Angela Gillespie, LPC
• Kara L Goforth, M.S., CCC-SLP/A
• Catherine Elizabeth Granai, FNP-C
• Dawn Grant, RN
• Dawn P Gravley, LCSW
• Rebekah Gravley, LPN
• Susan R Griffin, MD

• Optometrist in Wytheville, VA
• Providers in Wytheville, VA by specialty
• Optometrist in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 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.