NPIMap

Organization Active NPI

Grady D. Gafford MD PC

Doing business as Boardman Family EyeCare

  • Optometrist
  • Towanda, PA
National Provider Identifier
1942876917
Registry record updated Jun 1, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
Legal business name
GRADY D. GAFFORD MD PC
Doing business as
Boardman Family EyeCare
Practice address
899 Craft Master Road
Towanda, PA 18848-8936
Phone
(570) 265-3668
Fax
(570) 265-8936
NPI assigned
Jun 1, 2021
Last updated
Jun 1, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 1, 2021

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

Authorized official

Name
Jeanette A Fraser
Title
Office Manager
Phone
(570) 724-2131

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X Primary

Addresses

Primary practice location

899 Craft Master Road
Towanda, PA 18848-8936

Mailing address

15 Meade Street
Suite U-1
Wellsboro, PA 16901
Phone (570) 265-3668

Other names 1

  • Boardman Family EyeCare Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050420000869 PA Part B Supplier - Clinic/Group Practice 0042258048 Receives reassigned benefits from 6 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Towanda, PA; Wellsboro, PA; Troy, PA

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Grady D Gafford MD PC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

15 Meade St
Wellsboro, PA 16901
Phone (570) 724-2131

15 Meade St
Ste U1
Wellsboro, PA 16901
Phone (570) 724-2131

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1622505600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1622505600000",
    "number": "1942876917",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15 MEADE STREET",
            "address_2": "SUITE U-1",
            "city": "WELLSBORO",
            "state": "PA",
            "postal_code": "16901",
            "telephone_number": "570-265-3668",
            "fax_number": "570-265-8936"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "899 CRAFT MASTER ROAD",
            "city": "TOWANDA",
            "state": "PA",
            "postal_code": "188488936",
            "telephone_number": "570-265-3668",
            "fax_number": "570-265-8936"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRADY D. GAFFORD MD PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-06-01",
        "last_updated": "2021-06-01",
        "certification_date": "2021-05-27",
        "status": "A",
        "authorized_official_last_name": "FRASER",
        "authorized_official_first_name": "JEANETTE",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "570-724-2131"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Boardman Family EyeCare",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Towanda, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 1, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.