Active NPI
Optical Shop at Athens Eye Associates, Inc.
- Eyewear Supplier
- Bogart, GA
National Provider Identifier
1407094261
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Eyewear Supplier
- Legal business name
- OPTICAL SHOP AT ATHENS EYE ASSOCIATES, INC.
- Practice address
- 1080 Vend Dr
Suite 100
Bogart, GA 30622-3051 - Phone
- (706) 549-7047
- Fax
- (706) 613-5395
- NPI assigned
- Jan 31, 2009
- Organization subpart
- Yes
- Parent organization
- ATHENS EYE ASSOCIATES, P.C.
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Michael S. Jacobs, M.D.
- Title
- President
- Phone
- (706) 549-7047
Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Eyewear Supplier | 332H00000X | GA | Primary |
Addresses
Primary practice location
1080 Vend Dr
Suite 100
Bogart, GA 30622-3051
Mailing address
1080 Vend Dr
Suite 100
Bogart, GA 30622-3051
Phone (706) 549-7047
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 6325700001 | Other | GA | HUMANA |
| 6325700001 | Other | GA | UNITED HEALTHCARE |
National Provider Directory
National Provider Directory- Part of
- Athens Eye Associates PC
Practitioners & affiliated clinicians
Practitioners 2
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Ophthalmology Physician
- Watkinsville, GA
- NPI 1164495693
-
- Optometrist
- Lavonia, GA
- NPI 1124204813
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1233360000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1346198400000",
"number": "1407094261",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1080 VEND DR",
"address_2": "SUITE 100",
"city": "BOGART",
"state": "GA",
"postal_code": "306223051",
"telephone_number": "706-549-7047",
"fax_number": "706-613-5395"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1080 VEND DR",
"address_2": "SUITE 100",
"city": "BOGART",
"state": "GA",
"postal_code": "306223051",
"telephone_number": "706-549-7047",
"fax_number": "706-613-5395"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "OPTICAL SHOP AT ATHENS EYE ASSOCIATES, INC.",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "ATHENS EYE ASSOCIATES, P.C.",
"enumeration_date": "2009-01-31",
"last_updated": "2012-08-29",
"status": "A",
"authorized_official_last_name": "JACOBS",
"authorized_official_first_name": "MICHAEL",
"authorized_official_middle_name": "S.",
"authorized_official_title_or_position": "PRESIDENT",
"authorized_official_telephone_number": "706-549-7047",
"authorized_official_credential": "M.D."
},
"taxonomies": [
{
"code": "332H00000X",
"taxonomy_group": "",
"desc": "Eyewear Supplier",
"state": "GA",
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HUMANA",
"identifier": "6325700001",
"state": "GA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITED HEALTHCARE",
"identifier": "6325700001",
"state": "GA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Bogart, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 29, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.