Optique PCM

Primary specialty

OptometristTaxonomy code 152W00000X

License

1768 Issued in GA

Legal business name

OPTIQUE PCM

Practice address

650 North Ave NE
Suite S103
Atlanta, GA 30308-2705

Phone

(404) 875-2766

NPI assigned

Mar 4, 2015

Organization subpart

No

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

Authorized official

Name

Dr. Gavin Cohen, O.D.

Title

Owner

Phone

(404) 405-8539

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Karoo Doing business as

Locations

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

{
    "created_epoch": "1425427200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598572800000",
    "number": "1003208711",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1244 W PACES FERRY RD NW",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303272306",
            "telephone_number": "404-875-2766"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "650 NORTH AVE NE",
            "address_2": "SUITE S103",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303082705",
            "telephone_number": "404-875-2766"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OPTIQUE PCM",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-03-04",
        "last_updated": "2020-08-28",
        "certification_date": "2020-08-28",
        "status": "A",
        "authorized_official_last_name": "COHEN",
        "authorized_official_first_name": "GAVIN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "404-405-8539",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "GA",
            "license": "1768",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1760512040",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Karoo",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Karoo",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.