NPIMap

Organization Active NPI

Georgia Optometry Group Assoc. P.C.

Doing business as Georgia Optometry Group

  • Optometrist
  • Dunwoody, GA
National Provider Identifier
1124195631
Registry record updated Oct 14, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
Legal business name
GEORGIA OPTOMETRY GROUP ASSOC. P.C.
Doing business as
Georgia Optometry Group
Practice address
4480A Chamblee Dunwoody Road
Dunwoody, GA 30338
Phone
(770) 394-2110
Fax
(770) 394-5630
NPI assigned
Nov 29, 2006
Last updated
Oct 14, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 14, 2010

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

Authorized official

Name
Dr. Gary T PenceNPI 1316002926
Title
President
Phone
(770) 394-2110

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X NU Primary

Addresses

Primary practice location

4480A Chamblee Dunwoody Road
Dunwoody, GA 30338

Mailing address

4480A Chamblee Dunwoody Road
Dunwoody, GA 30338
Phone (770) 394-2110

Other identifiers 1

IdentifierTypeStateIssuer
GRP7409OtherGAGROUP I.D. NUMBER

Other names 1

  • Georgia Optometry Group Doing business as

National Provider Directory

National Provider Directory

Locations

2700 Town Center Dr NW
Ste H2
Kennesaw, GA 30144
Phone (770) 428-8090

1544 Southlake Pkwy
Ste 9B
Morrow, GA 30260
Phone (770) 394-2110

Practitioners & affiliated clinicians

Practitioners 2

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": "1164758400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1287014400000",
    "number": "1124195631",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4480A CHAMBLEE DUNWOODY ROAD",
            "city": "DUNWOODY",
            "state": "GA",
            "postal_code": "30338",
            "telephone_number": "770-394-2110",
            "fax_number": "770-394-5630"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4480A CHAMBLEE DUNWOODY ROAD",
            "city": "DUNWOODY",
            "state": "GA",
            "postal_code": "30338",
            "telephone_number": "770-394-2110",
            "fax_number": "770-394-5630"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GEORGIA OPTOMETRY GROUP ASSOC. P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-29",
        "last_updated": "2010-10-14",
        "status": "A",
        "authorized_official_last_name": "PENCE",
        "authorized_official_first_name": "GARY",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "770-394-2110",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP I.D. NUMBER",
            "identifier": "GRP7409",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Georgia Optometry Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Dunwoody, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 14, 2010; 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.