Michael Paul Bourgoin, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

9870T Issued in CA

Practice address

1835 Newport Blvd
Suite a-111
Costa Mesa, CA 92627-5031

Phone

(949) 646-4949

Fax

(949) 646-2533

NPI assigned

Aug 29, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in CA

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

Other, 1992

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Custom Eyes Optometry IncGroup PAC ID 8820008006, 2 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Custom Eyes Optometry, Inc.

  • Optometrist
  • Costa Mesa, CA
  • NPI 1548472921
  Medicare reassignment Care Compare group NPD Authorized official

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

{
    "created_epoch": "1156809600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1193961600000",
    "number": "1720197361",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1835 NEWPORT BLVD",
            "address_2": "SUITE A-111",
            "city": "COSTA MESA",
            "state": "CA",
            "postal_code": "926275031",
            "telephone_number": "949-646-4949",
            "fax_number": "949-646-2533"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1835 NEWPORT BLVD",
            "address_2": "SUITE A-111",
            "city": "COSTA MESA",
            "state": "CA",
            "postal_code": "926275031",
            "telephone_number": "949-646-4949",
            "fax_number": "949-646-2533"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOURGOIN",
        "first_name": "MICHAEL",
        "middle_name": "PAUL",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-29",
        "last_updated": "2007-11-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "9870T",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP NPI",
            "identifier": "1548472921",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CA OPTOMETRY LICENSE #",
            "identifier": "9870T",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PPIN",
            "identifier": "WOP9870I",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Robert G Bota, MD
• Alessandra Botello
• Nabil Botros
• Elliot Bouchan-Boche
• Troy David Boughner, PHARMD
• Alfred Bowen Jr.
• Caylin Mariah Bowen
• Macy Bowls
• Shawnna Boyd-Morrison, N.P.
• Barry J Boyd II, D.C.

• Optometrist in Costa Mesa, CA
• Providers in Costa Mesa, CA by specialty
• Optometrist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 2, 2007; 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.