Active NPI
Joel Rogol, OD
- Optometrist
- Lilburn, GA
National Provider Identifier
1316075476
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- OPT001637
- Practice address
- 4030 Lawrenceville Hwy NW
Lilburn, GA 30047-2820 - Phone
- (770) 806-8471
- Fax
- (404) 378-2681
- NPI assigned
- Mar 1, 2007
- Last updated
- Jul 8, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | OPT001637 | GA | Primary |
Addresses
Primary practice location
4030 Lawrenceville Hwy NW
Lilburn, GA 30047-2820
Mailing address
1434 Scott Blvd
Suite 2
Decatur, GA 30030-1424
Phone (404) 378-2622
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in GA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| OPT001637 | GA | MD | Optometrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Myeyedr Optometry of Georgia, LLC | Optometrist | Current | Accepting new patients |
| Myeyedr Optometry of Georgia, LLC | Optometrist | Current | Accepting new patients |
| Myeyedr Optometry of Georgia, LLC | Optometrist | Current | Accepting new patients |
| Fashion Optique Eyewear, Inc | Past | Accepting new patients |
Locations
4875 Altama Ave
Brunswick, GA 31520
Phone (912) 554-0010
1950 Old Gallows Rd
Ste 520
Vienna, VA 22182
8614 Westwood Center Dr
Fl 9
Vienna, VA 22182
Interoperability endpoints
- jrogol024015@myeyedr.emadirect.md
Organizations & group practices 4
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Optician
- Decatur, GA
- NPI 1457575680
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1172707200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1316075476",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1434 SCOTT BLVD",
"address_2": "SUITE 2",
"city": "DECATUR",
"state": "GA",
"postal_code": "300301424",
"telephone_number": "404-378-2622",
"fax_number": "404-378-2681"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4030 LAWRENCEVILLE HWY NW",
"city": "LILBURN",
"state": "GA",
"postal_code": "300472820",
"telephone_number": "770-806-8471",
"fax_number": "404-378-2681"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROGOL",
"first_name": "JOEL",
"credential": "OD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-03-01",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "GA",
"license": "OPT001637",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lilburn, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.