Neville Kersi Dalal, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

OPT003060 Issued in GA

Practice address

113 Lincoln St
Costco - Optometry
Woodstock, GA 30188

Phone

(770) 694-7208

NPI assigned

Jul 12, 2012

Last updated

Jan 26, 2021By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Optometry

Education

Illinois College of Optometry at Chicago, 2012

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Woodstock Eye Associates LLCGroup PAC ID 7618351487, 2 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Woodstock Eye Associates LLC

  • Optometrist
  • Woodstock, GA
  • NPI 1740890284
  Medicare reassignment Care Compare group NPD
• Singla Eye Care PC

  • Optometrist
  • Woodstock, GA
  • NPI 1376279620
  NPD Authorized official
• Emergency Medical & Surgical Specialists of Colorado LLC

  • Critical Access Hospital
  • Denver, CO
  • NPI 1144669102
  NPD (past)

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

{
    "created_epoch": "1342051200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1611619200000",
    "number": "1003171349",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1058 PIEDMONT AVE NE APT 403",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303093749"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "113 LINCOLN ST",
            "address_2": "COSTCO - OPTOMETRY",
            "city": "WOODSTOCK",
            "state": "GA",
            "postal_code": "30188",
            "telephone_number": "770-694-7208"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1550 Arbor Place Mall",
            "address_purpose": "LOCATION",
            "city": "Douglasville",
            "state": "GA",
            "postal_code": "301357108",
            "country_code": "US",
            "telephone_number": "770-852-1002",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DALAL",
        "first_name": "NEVILLE",
        "middle_name": "KERSI",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-07-12",
        "last_updated": "2021-01-26",
        "certification_date": "2021-01-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "GA",
            "license": "OPT003060",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jacek Czerwinski, DC
• D Thad Baird D M D P C (Baird & Baird Family Dentistry)
• Shelly-Ann Monique D'Cunha
• Osborne D'Souza, MD
• Anchita S Dalal, OD
• Montakia Princess Dance, LAPC
• Andrew Scott Daniel, PMHNP
• Alexis Daniels
• Katherine Garretson Darnell
• Attri Datta, M.D.

• Optometrist in Woodstock, GA
• Providers in Woodstock, GA by specialty
• Optometrist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 26, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.