GUOMIN JIANG (OD) – Optometrist, NPI 1174175749

GUOMIN JIANG (OD) is a healthcare provider. based in Louisville, Kentucky. specializing in Optometrist. They hold the professional credentials OD. They hold a License No. 2159DT (KY). The NPI Number for GUOMIN JIANG (OD) is 1174175749

Main info

Male
7 Years Of Experience
Accepts Medicare Assignment
Name
GUOMIN JIANG (OD)
NPI
1174175749
Phone
(502) 368-3937
Address
4940 HAZELWOOD AVE
Enumeration Date
12 July 2019
Last Update Date
12 July 2019

Doctor Profile

Medical School Name
INDIANA UNIVERSITY - SCHOOL OF OPTOMETRY
Secondary Phone
5023683937
Graduation Year
2019 (7 years ago)
PAC ID
6204164346
Group Practice PAC ID
4789651761
Professional Enrollment ID
I20190827002787
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience26
Completeness75
Years active:6State licenses:1Digital endpointsOther names

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Provider Addresses for GUOMIN JIANG (OD)

  • 4940, Hazelwood Avenue, Hazelwood, Louisville, Jefferson County, Kentucky, 40214, United States

    LOUISVILLE, KY 402141270

    Phone: (502) 368-3937

    Mailing address matches the actual address.

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

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: 2019-08-27

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

  1. Medicare enrolled
  2. On CMS revalidation list
  3. Due date assigned
  4. Revalidate in PECOS

CMS enrollment records

Enrollment IDTypeSpecialtyStateDue date
I20190827002787IOptometryKYTBD

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.

Verify on CMS Revalidation Lookup Tool

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.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 40214)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 4789651761View full group profile
NameSpecialtyState
O P H T H A L M O L O G YKY
O P H T H A L M O L O G YKY
O P H T H A L M O L O G YKY

Reviews

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Frequently asked questions

How do payers reference GUOMIN JIANG (OD)?
For GUOMIN JIANG (OD), use NPI 1174175749 as the unique 10-digit identifier.
Would GUOMIN JIANG (OD) appear as active to a payer?
You can treat GUOMIN JIANG (OD) as active for directory purposes; confirm clinical privileges separately.
What area of care is associated with GUOMIN JIANG (OD)?
GUOMIN JIANG (OD)'s record emphasizes Optometrist. Clinical services aligned with this taxonomy classification.
What locale is associated with GUOMIN JIANG (OD)?
Directory geography for GUOMIN JIANG (OD) centers on Louisville, Kentucky.
Does inactive status remove historical data?
Historical rows can remain visible after status changes — read the dates carefully.

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