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
- 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
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 09311 | Other | NC | BCBS OF NC |
| DE7256 | Other | NC | RAILROAD MEDICARE GROUP |
| 00343 | Other | AL | BLUE CROSS BLUE SHIELD |
| 8909311 | Medicaid | NC |
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 and National Provider Directory roles.
-
- Optometrist
- Greensboro, NC
- NPI 1962460170
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": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS OF NC",
"identifier": "09311",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE GROUP",
"identifier": "DE7256",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "00343",
"state": "AL"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "8909311",
"state": "NC"
}
],
"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.