Active NPI
G. Gavin Gerondale, O.D.
- Optometrist
- Houston, TX
National Provider Identifier
1760427413
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 3469TG
- Practice address
- 4901 Calhoun Rd
Houston, TX 77204-2020 - Phone
- (713) 743-2659
- Fax
- (713) 743-6541
- NPI assigned
- Jun 17, 2006
- 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 |
|---|---|---|---|---|
| Specialist | 174400000X | 03469TG | TX | |
| Optometrist | 152W00000X | 3469TG | TX | Primary |
Addresses
Primary practice location
4901 Calhoun Rd
Houston, TX 77204-2020
Mailing address
4901 Calhoun Rd
Room 2107
Houston, TX 77204-2020
Phone (713) 743-2659
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 093458003 | Medicaid | TX | |
| 1124091-04 | Medicaid | TX |
Other names 1
- Dr. G. Gavin Gerondale
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 |
|---|---|---|---|
| 3469TG | TX | MD | Optometrist |
| 03469TG | TX | MD | Specialist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Today's Vision at Rice Village | Optometrist | Past | Accepting new patients |
| Aeg Texas Professional PLLC | Optometrist | Past | Accepting new patients |
Organizations & group practices 2
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.
-
- Optometrist
- Kerrville, TX
- NPI 1457905937
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1150502400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1464307200000",
"number": "1760427413",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4901 CALHOUN RD",
"address_2": "ROOM 2107",
"city": "HOUSTON",
"state": "TX",
"postal_code": "772042020",
"telephone_number": "713-743-2659",
"fax_number": "713-743-6541"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4901 CALHOUN RD",
"city": "HOUSTON",
"state": "TX",
"postal_code": "772042020",
"telephone_number": "713-743-2659",
"fax_number": "713-743-6541"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GERONDALE",
"first_name": "G.",
"middle_name": "GAVIN",
"name_prefix": "Dr.",
"credential": "O.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-06-17",
"last_updated": "2016-05-27",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "TX",
"license": "03469TG",
"primary": false
},
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "TX",
"license": "3469TG",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "093458003",
"state": "TX"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1124091-04",
"state": "TX"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "G.",
"last_name": "GERONDALE",
"middle_name": "GAVIN",
"prefix": "DR.",
"credential": "O.D.",
"code": "2",
"type": "Professional Name"
}
]
}Other providers in Houston, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 27, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.