Individual provider Active NPI

Nelson Leonard Gould, O.D.

  • Optometrist
  • Fairfield, CT
National Provider Identifier
1780653378
Registry record updated Jul 6, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
933 Issued in CT
Practice address
2379 Black Rock Tpke
Fairfield, CT 06825-3229
Phone
(203) 333-5590
NPI assigned
Mar 16, 2006
Last updated
Jul 6, 2020By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 6, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 933 CT Primary
Low Vision Rehabilitation Optometrist 152WL0500X 933 CT

Addresses

Primary practice location

2379 Black Rock Tpke
Fairfield, CT 06825-3229

Mailing address

2379 Black Rock Tpke
Fairfield, CT 06825-3229
Phone (203) 333-5590

Other identifiers 1

IdentifierTypeStateIssuer
004086048MedicaidCT

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT
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
I20100120000667 CT Practitioner - Optometry 5698817211 Practice locations: Fairfield, CT

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Sostilio Eye Care LLC Optometrist CurrentSince May 8, 2022 Accepting new patients
Dr. Nelson Gould PastSince Oct 4, 1999 Accepting new patients
Weicholz & Belkin MD's Past Accepting new patients

Locations

2379 Black Rock Tpke
Fairfield, CT 06825
Phone (203) 333-5590

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": "1142467200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1593993600000",
    "number": "1780653378",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2379 BLACK ROCK TPKE",
            "city": "FAIRFIELD",
            "state": "CT",
            "postal_code": "068253229",
            "telephone_number": "203-333-5590",
            "fax_number": "203-333-6722"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2379 BLACK ROCK TPKE",
            "city": "FAIRFIELD",
            "state": "CT",
            "postal_code": "068253229",
            "telephone_number": "203-333-5590"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOULD",
        "first_name": "NELSON",
        "middle_name": "LEONARD",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-03-16",
        "last_updated": "2020-07-06",
        "certification_date": "2020-07-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CT",
            "license": "933",
            "primary": true
        },
        {
            "code": "152WL0500X",
            "taxonomy_group": "",
            "desc": "Optometrist, Low Vision Rehabilitation",
            "state": "CT",
            "license": "933",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004086048",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fairfield, CT

Sources for this page

Verify at the official NPI Registry.