Michael R Doucette Jr., LDO

Primary specialty

OpticianTaxonomy code 156FX1800X

License

LDO002685 Issued in GA

Practice address

180 Toccoa CT
Ellijay, GA 30540-0604

Phone

(770) 402-1175

NPI assigned

Oct 27, 2023

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Blue Ridge Vision, Inc.

  • Optometrist
  • Ellijay, GA
  • NPI 1235724774
  NPD Authorized official
• Bradley Eye Associates, Inc

  • Optometrist
  • East Ellijay, GA
  • NPI 1851619506
  NPD

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

{
    "created_epoch": "1698364800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1698364800000",
    "number": "1275305708",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "180 TOCCOA CT",
            "city": "ELLIJAY",
            "state": "GA",
            "postal_code": "305400604"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "180 TOCCOA CT",
            "city": "ELLIJAY",
            "state": "GA",
            "postal_code": "305400604",
            "telephone_number": "770-402-1175"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DOUCETTE",
        "first_name": "MICHAEL",
        "middle_name": "R",
        "name_prefix": "Mr.",
        "name_suffix": "Jr.",
        "credential": "LDO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-10-27",
        "last_updated": "2023-10-27",
        "certification_date": "2023-10-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "156FX1800X",
            "taxonomy_group": "",
            "desc": "Technician/Technologist, Optician",
            "state": "GA",
            "license": "LDO002685",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rebecca Vinson D'Angelo, OT
• Jill Lorren Darling, D.C.
• Maggie Louise Dear, PA
• Dialysis of North Atlanta LLC
• Dietary Apothecary Inc.
• Draneco Inc
• Bradleigh Dyer-McPherson, FNP
• Ellijay Center for Change, PC
• Jackie Dwayne Ellington, EMT
• Stacey Lynne Evans-Paulin, PA-C

• Optician in Ellijay, GA
• Providers in Ellijay, GA by specialty
• Optician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 27, 2023; 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.