Active NPI
Beverly Anne Gough, O.D.
- Optometrist
- Vienna, VA
National Provider Identifier
1811063142
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 1351
- Practice address
- 1950 Old Gallows Rd
Suite 520
Vienna, VA 22182-3990 - Phone
- (703) 847-8899
- Fax
- (703) 991-0514
- NPI assigned
- Nov 28, 2006
- Last updated
- Nov 5, 2014
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Optometrist | 152W00000X | S-680 TA-388 | AL | |
| Optometrist | 152W00000X | 1351 | NC | Primary |
Addresses
Primary practice location
1950 Old Gallows Rd
Suite 520
Vienna, VA 22182-3990
Mailing address
1950 Old Gallows Rd
Suite 520
Vienna, VA 22182-3990
Phone (703) 847-8899
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 |
|---|---|---|---|
| S-680 TA-388 | AL | MD | Optometrist |
| 1351 | NC | MD | Physical Therapy Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Myeyedr Optometry of North Carolina PLLC | Optometrist | Past | Accepting new patients |
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, 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": "1164672000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1415145600000",
"number": "1811063142",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1950 OLD GALLOWS RD",
"address_2": "SUITE 520",
"city": "VIENNA",
"state": "VA",
"postal_code": "221823990",
"telephone_number": "703-847-8899",
"fax_number": "703-991-0514"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1950 OLD GALLOWS RD",
"address_2": "SUITE 520",
"city": "VIENNA",
"state": "VA",
"postal_code": "221823990",
"telephone_number": "703-847-8899",
"fax_number": "703-991-0514"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GOUGH",
"first_name": "BEVERLY",
"middle_name": "ANNE",
"name_prefix": "Dr.",
"credential": "O.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-11-28",
"last_updated": "2014-11-05",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "AL",
"license": "S-680 TA-388",
"primary": false
},
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "NC",
"license": "1351",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Vienna, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 5, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.