NPIMap

Organization Active NPI

D & G Eye Associates, LLC

  • Optometrist
  • Edgewater, MD
National Provider Identifier
1982104105
Registry record updated Feb 14, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
TA2312 Issued in MD
Legal business name
D & G EYE ASSOCIATES, LLC
Practice address
137 Mitchells Chance Rd Ste 120
Edgewater, MD 21037-2793
Phone
(410) 956-2200
NPI assigned
Feb 14, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 14, 2018

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

Authorized official

Name
Aidin Dean Gogerdchi, ODNPI 1316201668
Title
Owner
Phone
(410) 562-6636

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X TA2312 MD Primary
Corneal and Contact Management OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152WC0802X TA2312 MD
Pediatric OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152WP0200X TA2312 MD

Addresses

Primary practice location

137 Mitchells Chance Rd Ste 120
Edgewater, MD 21037-2793

Mailing address

137 Mitchells Chance Rd Ste 120
Edgewater, MD 21037-2793

Other names 1

  • Tidewater Family Eye Care Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20180424000075 MD Part B Supplier - Clinic/Group Practice 1658634761 Receives reassigned benefits from 2 practitioners
Practice locations: Edgewater, MD

National Provider Directory

National Provider Directory

Locations

137 Mitchells Chance Rd
Ste 120
Edgewater, MD 21037
Phone (410) 956-2200

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1518566400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1518566400000",
    "number": "1982104105",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "137 MITCHELLS CHANCE RD STE 120",
            "city": "EDGEWATER",
            "state": "MD",
            "postal_code": "210372793"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "137 MITCHELLS CHANCE RD STE 120",
            "city": "EDGEWATER",
            "state": "MD",
            "postal_code": "210372793",
            "telephone_number": "410-956-2200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "D & G EYE ASSOCIATES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-02-14",
        "last_updated": "2018-02-14",
        "status": "A",
        "authorized_official_last_name": "GOGERDCHI",
        "authorized_official_first_name": "AIDIN",
        "authorized_official_middle_name": "DEAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "410-562-6636",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "MD",
            "license": "TA2312",
            "primary": true
        },
        {
            "code": "152WC0802X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist, Corneal and Contact Management",
            "state": "MD",
            "license": "TA2312",
            "primary": false
        },
        {
            "code": "152WP0200X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist, Pediatrics",
            "state": "MD",
            "license": "TA2312",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Tidewater Family Eye Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Edgewater, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 14, 2018; 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.