Individual provider Active NPI

Gregory Alisson Mansur, OD

  • Optometrist
  • Lakewood, CO
National Provider Identifier
1750925624
Registry record updated Feb 5, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
OPT.0003542 Issued in CO
Practice address
460 S Vance St
Lakewood, CO 80226-3305
Phone
(303) 209-5133
NPI assigned
Nov 4, 2019
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 5, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X OPT.0003542 CO Primary

Addresses

Primary practice location

460 S Vance St
Lakewood, CO 80226-3305

Mailing address

8949 W 50TH LN Unit 3
Arvada, CO 80002-4445
Phone (786) 543-8414

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO
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
I20250226000202 CO Practitioner - Optometry 2062932601 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Illinois College of Optometry at Chicago, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

460 S Vance St
Lakewood, CO 80226-3305
Phone (303) 209-5133

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
OPT.0003542COMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Visionview Eyecare LTD. Optometrist CurrentSince Jan 12, 2025 Accepting new patients

Locations

460 S Vance St
Lakewood, CO 80226
Phone (303) 209-5133

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1572825600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1738713600000",
    "number": "1750925624",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8949 W 50TH LN UNIT 3",
            "city": "ARVADA",
            "state": "CO",
            "postal_code": "800024445",
            "telephone_number": "786-543-8414"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "460 S VANCE ST",
            "city": "LAKEWOOD",
            "state": "CO",
            "postal_code": "802263305",
            "telephone_number": "303-209-5133"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANSUR",
        "first_name": "GREGORY",
        "middle_name": "ALISSON",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2019-11-04",
        "last_updated": "2025-02-05",
        "certification_date": "2025-02-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CO",
            "license": "OPT.0003542",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lakewood, CO

Sources for this page

Verify at the official NPI Registry.