Active NPI
Gary Wilbur Vickers, O.D.
- Optometrist
- Louisville, KY
National Provider Identifier
1912986266
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 775DT
- Practice address
- 3301 Mount Shasta Way
Louisville, KY 40241-6213 - Phone
- (502) 425-5839
- NPI assigned
- Jan 14, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 775DT | KY | Primary |
Addresses
Primary practice location
3301 Mount Shasta Way
Louisville, KY 40241-6213
Mailing address
3301 Mount Shasta Way
Louisville, KY 40241-6213
Phone (502) 425-5839
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1137196800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1303516800000",
"number": "1912986266",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3301 MOUNT SHASTA WAY",
"city": "LOUISVILLE",
"state": "KY",
"postal_code": "402416213",
"telephone_number": "502-425-5839"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3301 MOUNT SHASTA WAY",
"city": "LOUISVILLE",
"state": "KY",
"postal_code": "402416213",
"telephone_number": "502-425-5839"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VICKERS",
"first_name": "GARY",
"middle_name": "WILBUR",
"credential": "O.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-01-14",
"last_updated": "2011-04-23",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "KY",
"license": "775DT",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Louisville, KY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 23, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.