Highland Eye Boutique, LLC

Primary specialty

OptometristTaxonomy code 152W00000X

License

OPT002410 Issued in GA

Legal business name

HIGHLAND EYE BOUTIQUE, LLC

Practice address

1056 N Highland Ave NE
Atlanta, GA 30306-3551

Phone

(404) 343-0887

Fax

(404) 343-2024

NPI assigned

Apr 1, 2010

Last updated

May 4, 2016By 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

Kristie Bennett, ODNPI 1427008705

Title

Manager

Phone

(404) 343-0887

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.

• Kristie J Bennett, OD

  • Optometrist
  • Atlanta, GA
  • NPI 1427008705
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1270080000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1462320000000",
    "number": "1285959346",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1056 N HIGHLAND AVE NE",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303063551",
            "telephone_number": "404-343-0887",
            "fax_number": "404-343-2024"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1056 N HIGHLAND AVE NE",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303063551",
            "telephone_number": "404-343-0887",
            "fax_number": "404-343-2024"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HIGHLAND EYE BOUTIQUE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-04-01",
        "last_updated": "2016-05-04",
        "status": "A",
        "authorized_official_last_name": "BENNETT",
        "authorized_official_first_name": "KRISTIE",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "404-343-0887",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "GA",
            "license": "OPT002410",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 4, 2016; 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.