NPIMap

Organization Active NPI

Roswell Eye Clinic,Inc

  • Optometrist
  • Roswell, GA
National Provider Identifier
1104010594
Registry record updated Feb 28, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
861-T Issued in GA
Legal business name
ROSWELL EYE CLINIC,INC
Doing business as
Roswell Eye Clinic,Inc
Practice address
1190 Grimes Bridge Rd
Roswell, GA 30075-3930
Phone
(770) 992-7620
Fax
(770) 992-8262
NPI assigned
Aug 29, 2007
Last updated
Feb 28, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 28, 2011

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

Authorized official

Name
Dr. Sharon B Moscow
Title
Optometrist
Phone
(770) 992-7620

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X 861-T GA Primary

Addresses

Primary practice location

1190 Grimes Bridge Rd
Roswell, GA 30075-3930

Mailing address

1190 Grimes Bridge Rd
Roswell, GA 30075-3930
Phone (770) 992-7620

Other identifiers 1

IdentifierTypeStateIssuer
00168583AMedicaidGA

Other names 1

  • Roswell Eye Clinic,Inc Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110315000050 GA Part B Supplier - Clinic/Group Practice 7214119114 Receives reassigned benefits from 8 practitioners
Practice locations: Roswell, GA

National Provider Directory

National Provider Directory

Locations

1190 Grimes Bridge Rd
Roswell, GA 30075
Phone (770) 992-7620

1190 Grimes Bridge Rd
Ste E
Roswell, GA 30075

Practitioners & affiliated clinicians

Practitioners 9

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.

NPI Registry JSON

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

{
    "created_epoch": "1188345600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1298851200000",
    "number": "1104010594",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1190 GRIMES BRIDGE RD",
            "city": "ROSWELL",
            "state": "GA",
            "postal_code": "300753930",
            "telephone_number": "770-992-7620",
            "fax_number": "770-992-8262"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1190 GRIMES BRIDGE RD",
            "city": "ROSWELL",
            "state": "GA",
            "postal_code": "300753930",
            "telephone_number": "770-992-7620",
            "fax_number": "770-992-8262"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROSWELL EYE CLINIC,INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-08-29",
        "last_updated": "2011-02-28",
        "status": "A",
        "authorized_official_last_name": "MOSCOW",
        "authorized_official_first_name": "SHARON",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "OPTOMETRIST",
        "authorized_official_telephone_number": "770-992-7620",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "GA",
            "license": "861-T",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00168583A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Roswell Eye Clinic,Inc",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Roswell, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 28, 2011; 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.