Gabriel Dery, O.D.

Primary specialty

Corneal and Contact Management OptometristTaxonomy code 152WC0802X

License

5841T Issued in CA

Practice address

28521 Paseo Diana
San Juan Capistrano, CA 92675-2905

Phone

(949) 275-7539

Fax

(949) 496-2034

NPI assigned

Jul 10, 2006

Sex

Male

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 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

Flagged The directory lists this NPI on an HHS exclusion list. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

State licenses

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

{
    "created_epoch": "1152489600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1730113291",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "28521 PASEO DIANA",
            "city": "SAN JUAN CAPISTRANO",
            "state": "CA",
            "postal_code": "926752905",
            "telephone_number": "949-275-7539",
            "fax_number": "949-496-2034"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "28521 PASEO DIANA",
            "city": "SAN JUAN CAPISTRANO",
            "state": "CA",
            "postal_code": "926752905",
            "telephone_number": "949-275-7539",
            "fax_number": "949-496-2034"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DERY",
        "first_name": "GABRIEL",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-10",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152WC0802X",
            "taxonomy_group": "",
            "desc": "Optometrist, Corneal and Contact Management",
            "state": "CA",
            "license": "5841T",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "T006",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Corneal and Contact Management Optometrist in San Juan Capistrano, CA
• Providers in San Juan Capistrano, CA by specialty
• Corneal and Contact Management Optometrist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.