NPIMap

Organization Active NPI

Atl Optical LLC

  • Eyewear Supplier
  • Atlanta, GA
National Provider Identifier
1154085306
Registry record updated Oct 25, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Eyewear SupplierTaxonomy code 332H00000X
Legal business name
ATL OPTICAL LLC
Practice address
1671 Howell Mill Rd NW
Atlanta, GA 30318-3118
Phone
(956) 335-6476
NPI assigned
Oct 25, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 25, 2021

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

Authorized official

Name
Jackie Bennett
Title
Credentialing Supervisor
Phone
(561) 433-6009

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X
Eyewear Supplier 332H00000X Primary

Addresses

Primary practice location

1671 Howell Mill Rd NW
Atlanta, GA 30318-3118

Mailing address

1943 Pleasant Hill Rd
Duluth, GA 30096-4625

Other names 1

  • My EyeLab Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Atl Optical LLC10 organizations share this tax ID, including this one

Other organizations with this tax ID 9

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1671 Howell Mill Rd NW
Atlanta, GA 30318

NPI Registry JSON

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

{
    "created_epoch": "1635120000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1635120000000",
    "number": "1154085306",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1943 PLEASANT HILL RD",
            "city": "DULUTH",
            "state": "GA",
            "postal_code": "300964625"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1671 HOWELL MILL RD NW",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303183118",
            "telephone_number": "956-335-6476"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ATL OPTICAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-10-25",
        "last_updated": "2021-10-25",
        "certification_date": "2021-10-25",
        "status": "A",
        "authorized_official_last_name": "BENNETT",
        "authorized_official_first_name": "JACKIE",
        "authorized_official_title_or_position": "CREDENTIALING SUPERVISOR",
        "authorized_official_telephone_number": "561-433-6009"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "332H00000X",
            "taxonomy_group": "",
            "desc": "Eyewear Supplier",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "My EyeLab",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Atlanta, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 25, 2021; 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.