NPIMap

Individual provider Active NPI

Rodney N Gilliland, O.D.

  • Optometrist
  • Acoma, NM
National Provider Identifier
1801800016
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
8301949-9934 Issued in UT
Practice address
80 B Veterans Blvd
Acoma, NM 87034
Phone
(505) 552-5300
Fax
(505) 552-5490
NPI assigned
Jul 27, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 6929T CA
Optometrist 152W00000X 8301949-9934 UT Primary

Addresses

Primary practice location

80 B Veterans Blvd
Acoma, NM 87034

Mailing address

PO Box 130
San Fidel, NM 87049-0130
Phone (505) 552-5300

Other identifiers 1

IdentifierTypeStateIssuer
H3450MedicaidNM

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20140219001803 TX Practitioner - Optometry 5496751992 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
Flagged The directory lists this NPI on an HHS exclusion list. Confirm with the OIG exclusions search.

State licenses

LicenseStateTypeSpecialty
6929TCAMDOptometrist
8301949-9934UTMDOptometrist
6929CAMDCertified Respiratory Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Mescalero Indian Hospital CurrentSince Oct 29, 2020 Accepting new patients
Standard Optical Co Optometrist Past Accepting new patients
Kayenta Alternative Rural Hospital Past Accepting new patients
Standard Optical Co Optometrist Past Accepting new patients
Standard Optical Co Optometrist Past Accepting new patients
Standard Optical Company Optometrist Past Accepting new patients
Standard Optical Co Optometrist Past Accepting new patients
Standard Optical Co Optometrist Past Accepting new patients
Standard Optical Co Optometrist Past Accepting new patients
Standard Optical Co Optometrist Past Accepting new patients

Organizations & group practices 10

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": "1153958400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1801800016",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 130",
            "city": "SAN FIDEL",
            "state": "NM",
            "postal_code": "870490130",
            "telephone_number": "505-552-5300",
            "fax_number": "505-552-5490"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "80 B VETERANS BLVD",
            "city": "ACOMA",
            "state": "NM",
            "postal_code": "87034",
            "telephone_number": "505-552-5300",
            "fax_number": "505-552-5490"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GILLILAND",
        "first_name": "RODNEY",
        "middle_name": "N",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-27",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "6929T",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "UT",
            "license": "8301949-9934",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "H3450",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Acoma, NM

Sources for this page

Verify at the official NPI Registry.