Lake Lanier Eye Care, LLC

Primary specialty

OptometristTaxonomy code 152W00000X

License

OPT002752 Issued in GA

Legal business name

LAKE LANIER EYE CARE, LLC

Practice address

5885 Cumming Hwy Ste 401-402
Sugar Hill, GA 30518-5765

Phone

(678) 926-3525

NPI assigned

Oct 28, 2014

Last updated

Jun 3, 2021By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Brett Bordner, ODNPI 1578904314

Title

Owner

Phone

(662) 910-0735

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Rohan Kapoor, O.D.

  • Optometrist
  • Alpharetta, GA
  • NPI 1689027948
  Medicare reassignment Care Compare group NPD
• Derek Alan Black, O.D.

  • Optometrist
  • Cumming, GA
  • NPI 1114353232
  Medicare reassignment Care Compare group
• Brett S Bordner, OD

  • Optometrist
  • Oakwood, GA
  • NPI 1578904314
  Medicare reassignment Authorized official

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

{
    "created_epoch": "1414454400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1622678400000",
    "number": "1013312453",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "205 HIGHLAND GATE CIR",
            "city": "SUWANEE",
            "state": "GA",
            "postal_code": "300241795",
            "telephone_number": "662-910-0735"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5885 CUMMING HWY STE 401-402",
            "city": "SUGAR HILL",
            "state": "GA",
            "postal_code": "305185765",
            "telephone_number": "678-926-3525"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE LANIER EYE CARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-10-28",
        "last_updated": "2021-06-03",
        "certification_date": "2021-06-03",
        "status": "A",
        "authorized_official_last_name": "BORDNER",
        "authorized_official_first_name": "BRETT",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "662-910-0735",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "GA",
            "license": "OPT002752",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Bridgett Lynn Jorgensen, D.M.D.
• Just Heal Counseling
• Daesung Kim
• Mark Andrew Kral, RPH
• Paul Stanley Kudyba Jr., DDS
• Zachary Lakebrink
• Millicent Lampa, RD
• Kristy Williams Larson, PHARMD
• Kimberly Loan Le, NP
• Hallye S. Lee, MS, LPC, NCC

• Optometrist in Sugar Hill, GA
• Providers in Sugar Hill, GA by specialty
• Optometrist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 3, 2021; 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.