Bolt Eye Group - Lawrenceville LLC

Primary specialty

OptometristTaxonomy code 152W00000X

Legal business name

BOLT EYE GROUP - LAWRENCEVILLE LLC

Practice address

575 Professional Dr
Lawrenceville, GA 30046-3333

Phone

(678) 993-2020

NPI assigned

Jul 16, 2024

Last updated

Jul 16, 2024By 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

Barbra Williams

Title

Coo

Phone

(770) 776-9000

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

Locations

Practitioners 1

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.

• Mehdi Kazemzadeh, O.D.

  • Corneal and Contact Management Optometrist
  • Lawrenceville, GA
  • NPI 1306921101
  Medicare reassignment NPD

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

{
    "created_epoch": "1721088000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1721088000000",
    "number": "1154169985",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "575 PROFESSIONAL DR",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "300463333",
            "telephone_number": "678-993-2020"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "575 PROFESSIONAL DR",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "300463333",
            "telephone_number": "678-993-2020"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BOLT EYE GROUP - LAWRENCEVILLE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-07-16",
        "last_updated": "2024-07-16",
        "certification_date": "2024-07-16",
        "status": "A",
        "authorized_official_last_name": "WILLIAMS",
        "authorized_official_first_name": "BARBRA",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "770-776-9000"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• John G Bojack, CRNA
• Bold Steps ABA of Ga LLC
• Bolen Chiropractic, Inc.
• Angela Y Bolger, CRNP
• Kavita Vanguru Bollavaram, M.D
• Katherine Bonas, M.ED., CCC-SLP
• Pauline Carmela Bondoc-Roaquin, P.T.
• Joan Boneberg, M.S.
• Alahni Bones
• Stephanie Carolina Bono

• Optometrist in Lawrenceville, GA
• Providers in Lawrenceville, GA by specialty
• Optometrist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 2024; 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.