Individual provider Active NPI

Kevin Nehaul, O.D.

  • Optometrist
  • Alpharetta, GA
National Provider Identifier
1043596000
Registry record updated Jul 26, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
OPC4775 Issued in FL
Practice address
1000 N Point Cir Ste 1014
Alpharetta, GA 30022-4853
Phone
(678) 893-0660
NPI assigned
Oct 21, 2011
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 26, 2014

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 1667 SC
Optometrist 152W00000X OPT002674 GA
Optometrist 152W00000X OPC4775 FL Primary

Addresses

Primary practice location

1000 N Point Cir Ste 1014
Alpharetta, GA 30022-4853

Mailing address

19070 Bruce B Downs Blvd
Tampa, FL 33647-2477
Phone (813) 632-2020

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20120201000498 GA Practitioner - Optometry 5092972117 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
OPC4775FLMDOptometrist
1667SCMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Mark Lynn O.D. & Associates, PC CurrentSince Dec 23, 2011 Accepting new patients
Mark Lynn OD & Associates, PC Optometrist CurrentSince Dec 23, 2011 Accepting new patients
Samuel J Teske OD PA Optometrist PastSince Jul 4, 2011 Accepting new patients
True Eye Experts West Palm LLC Optometrist PastSince Sep 12, 2021 Accepting new patients

Locations

2929 Turner Hill Rd
Ste 2625
Lithonia, GA 30038
Phone (770) 482-5050

Organizations & group practices 4

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

NPI Registry JSON

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

{
    "created_epoch": "1319155200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1406332800000",
    "number": "1043596000",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19070 BRUCE B DOWNS BLVD",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336472477",
            "telephone_number": "813-632-2020"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 N POINT CIR STE 1014",
            "city": "ALPHARETTA",
            "state": "GA",
            "postal_code": "300224853",
            "telephone_number": "678-893-0660"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NEHAUL",
        "first_name": "KEVIN",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2011-10-21",
        "last_updated": "2014-07-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "SC",
            "license": "1667",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "GA",
            "license": "OPT002674",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "FL",
            "license": "OPC4775",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Alpharetta, GA

Sources for this page

Verify at the official NPI Registry.