Individual provider Active NPI

Ann Inman Gaylord, O.D.

  • Optometrist
  • Garden Grove, CA
National Provider Identifier
1851561930
Registry record updated Jul 14, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
9265 Issued in CA
Practice address
12902 Brookhurst St
Ste a
Garden Grove, CA 92840-4881
Phone
(714) 530-5050
NPI assigned
Mar 5, 2008
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 14, 2009

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 9265 CA Primary

Addresses

Primary practice location

12902 Brookhurst St
Ste a
Garden Grove, CA 92840-4881

Mailing address

3756 Santa Rosalia Dr
Ste. #100
Los Angeles, CA 90008-3606
Phone (714) 377-9866

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
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
I20090721000410 CA Practitioner - Optometry 4981765617 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Southern California College of Optometry, 1989
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Optometric Specialties IncGroup PAC ID 9234194556, 2 clinicians

Practice addresses (Care Compare)

12902 Brookhurst St
Suite a
Garden Grove, CA 92840-4881
Phone (714) 530-5050

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
9265CAMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Optometric Specialties Inc Optometrist CurrentSince May 21, 2009 Accepting new patients
Optometric Specialties Inc Optometrist CurrentSince May 21, 2009 Accepting new patients

Locations

12902 Brookhurst St
Ste A
Garden Grove, CA 92840
Phone (714) 530-2020

3756 Santa Rosalia Dr
Ste 100
Los Angeles, CA 90008
Phone (323) 294-7517

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.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1204675200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1247529600000",
    "number": "1851561930",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3756 SANTA ROSALIA DR",
            "address_2": "STE. #100",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900083606",
            "telephone_number": "714-377-9866"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12902 BROOKHURST ST",
            "address_2": "STE A",
            "city": "GARDEN GROVE",
            "state": "CA",
            "postal_code": "928404881",
            "telephone_number": "714-530-5050"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GAYLORD",
        "first_name": "ANN",
        "middle_name": "INMAN",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-03-05",
        "last_updated": "2009-07-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "9265",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Garden Grove, CA

Sources for this page

Verify at the official NPI Registry.