Individual provider Active NPI

Courtney Marie Gonzales, O.D.

  • Optometrist
  • Carmel, IN
National Provider Identifier
1720342553
Registry record updated Jul 12, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
18004081A Issued in IN
Practice address
11450 N Meridian St Ste 120
Carmel, IN 46032-4688
Phone
(317) 872-8772
NPI assigned
Jun 26, 2012
Last updated
Jul 12, 2019By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 12, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 18004081A IN Primary

Addresses

Primary practice location

11450 N Meridian St Ste 120
Carmel, IN 46032-4688

Mailing address

11450 N Meridian St Ste 120
Carmel, IN 46032-4688
Phone (317) 872-8772

Other practice location 1

10401 N Michigan Rd
Carmel, IN 46032-7939
Phone (317) 876-0936

Other practice location 2

11845 Allisonville Rd Ste 300
Fishers, IN 46038-2313
Phone (317) 585-9295

Other identifiers 1

IdentifierTypeStateIssuer
991378001MedicaidIN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN
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
I20180801003281 IN Practitioner - Optometry 8022249770 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
University of Missouri St Louis - School of Optometry, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Barrett Eye Care, LLCGroup PAC ID 8628030285, 2 clinicians

Practice addresses (Care Compare)

11450 N Meridian St
Suite 120
Carmel, IN 46032-4688
Phone (317) 872-8772

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
18004081AINMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Barrett Eye Care, LLC CurrentSince Jan 1, 2019 Accepting new patients
DRS. Lauck and McLean Optometrist PastSince Jun 3, 2018 Accepting new patients
Jeremy Ciano, PC Optometrist PastSince May 25, 2014 Accepting new patients

Locations

11450 N Meridian St
Ste 120
Carmel, IN 46032
Phone (317) 872-8772

11845 Allisonville Rd
Ste 300
Fishers, IN 46038
Phone (317) 585-9292

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1340668800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1562889600000",
    "number": "1720342553",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11450 N MERIDIAN ST STE 120",
            "city": "CARMEL",
            "state": "IN",
            "postal_code": "460324688",
            "telephone_number": "317-872-8772"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11450 N MERIDIAN ST STE 120",
            "city": "CARMEL",
            "state": "IN",
            "postal_code": "460324688",
            "telephone_number": "317-872-8772"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "10401 N Michigan Rd",
            "address_purpose": "LOCATION",
            "city": "Carmel",
            "state": "IN",
            "postal_code": "460327939",
            "country_code": "US",
            "telephone_number": "317-876-0936",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "11845 Allisonville Rd Ste 300",
            "address_purpose": "LOCATION",
            "city": "Fishers",
            "state": "IN",
            "postal_code": "460382313",
            "country_code": "US",
            "telephone_number": "317-585-9295",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GONZALES",
        "first_name": "COURTNEY",
        "middle_name": "MARIE",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-06-26",
        "last_updated": "2019-07-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "IN",
            "license": "18004081A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "991378001",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Carmel, IN

Sources for this page

Verify at the official NPI Registry.