KELLY BOURGON (OD) – Optometrist, NPI 1194213751
Optometrist
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
1,977 OPTOMETRY in NY
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Provider Addresses for KELLY BOURGON (OD)
1768 S TAFT AVE APT 103
LOVELAND, CO 805377291
Phone: (207) 356-5387
Type: Mailing
9, Harbor Drive, South Brewer, Brewer, Penobscot County, Maine, 04412, United States
BREWER, ME 044122534
Phone: (207) 356-5387
Type: Mailing
Watertown Eye Center, 1815, State Street, Watertown, Jefferson County, New York, 13601, United States
WATERTOWN, NY 13601
Phone: (315) 788-6070
Type: Location
412 MAIN ST
LONGMONT, CO 805015535
Phone: (303) 651-6700
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 5 Open Payments records for all available years, with a total value of $186.
Total Amount is formed as General ($186) + Research ($0) + Ownership ($0) = $186.
Last reported payment date: 2024-09-11 • Largest payer in this snapshot: Johnson & Johnson Vision Care, Inc. ($105).
Total Amount
$186
General + Research + Ownership
Payments
5
Total payment records
General Amount
$186
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2024-09-11
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| Johnson & Johnson Vision Care, Inc. | $105 |
| Bausch & Lomb Americas Inc. | $42 |
| Alcon Vision LLC | $39 |
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2020-09-17
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.
Enrollment records
1
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20200917003222 | I | Optometry | CO | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
Top Medicare procedures (2023) · refreshed 2026-05-27
| HCPCS | Description | Services | Beneficiaries | Medicare allowed |
|---|---|---|---|---|
| 99213 | Established patient office or other outpatient visit, 20-29 minutes | 66 | 65 | $0 |
| 92250 | Photography of the retina | 39 | 38 | $0 |
| 99212 | Established patient office or other outpatient visit, 10-19 minutes | 33 | 25 | $0 |
Insurance plans in this area (ZIP 80537)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| O P T O M E T R Y | CO | |
| O P T O M E T R Y | IA | |
| O P T O M E T R Y | IA | |
| - | CO | |
| O P T O M E T R Y | IA | |
| O P T O M E T R Y | VA | |
| O P T O M E T R Y | IA | |
| O P T O M E T R Y | NC | |
| O P T O M E T R Y | CO | |
| O P T O M E T R Y | IA |
Reviews
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