Active NPI
Gary E. Oliver, O.D.
- Optometrist
- Brookhaven, PA
National Provider Identifier
1720170251
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- OEG001880
- Practice address
- 4590 Edgmont Ave
Brookhaven, PA 19015-1728 - Phone
- (610) 872-6077
- Fax
- (610) 872-2845
- NPI assigned
- Sep 29, 2006
- Last updated
- Feb 1, 2017
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | OEG001880 | PA | Primary |
| Optometrist | 152W00000X | TUV005129 | NY |
Addresses
Primary practice location
4590 Edgmont Ave
Brookhaven, PA 19015-1728
Mailing address
4590 Edgmont Ave
Brookhaven, PA 19015-1728
Phone (610) 872-6077
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| TUV005129 | NY | MD | Optometrist |
| OEG001880 | PA | MD | Optometrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Casseys Optical, Inc | Past | Accepting new patients |
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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Durable Medical Equipment & Medical Supplies
- Brookhaven, PA
- NPI 1821035759
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159488000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1485907200000",
"number": "1720170251",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4590 EDGMONT AVE",
"city": "BROOKHAVEN",
"state": "PA",
"postal_code": "190151728",
"telephone_number": "610-872-6077",
"fax_number": "610-872-2845"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4590 EDGMONT AVE",
"city": "BROOKHAVEN",
"state": "PA",
"postal_code": "190151728",
"telephone_number": "610-872-6077",
"fax_number": "610-872-2845"
}
],
"practiceLocations": [],
"basic": {
"last_name": "OLIVER",
"first_name": "GARY",
"middle_name": "E.",
"credential": "O.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-09-29",
"last_updated": "2017-02-01",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "PA",
"license": "OEG001880",
"primary": true
},
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "NY",
"license": "TUV005129",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Brookhaven, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 1, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.